Two complete 1918 influenza A/H1N1 pandemic virus genomes characterized by next-generation sequencing using RNA isolated from formalin-fixed, paraffin-embedded autopsy lung tissue samples along with evidence of secondary bacterial co-infection

The 1918 influenza pandemic was the most devastating respiratory pandemic in modern human history, with 50-100 million deaths worldwide. Here, we characterized the complete genomes of influenza A virus (IAV) from two fatal cases during the fall wave of 1918 influenza A (H1N1) pandemic in the United States, one from Walter Reed Army Hospital in Washington, DC, and the other from Camp Jackson, SC. The two complete IAV genomes were obtained by combining Illumina deep sequencing data from both total RNA and influenza viral genome-enriched libraries along with Sanger sequencing data from PCR across the sequencing gaps. This study confirms the previously reported 1918 IAV genomes and increases the total number of available complete or near-complete influenza viral genomes of the 1918 pandemic from four to six. Sequence comparisons among them confirm that the genomes of the 1918 pandemic virus were highly conserved during the main wave of the pandemic with geographic separation in North America and Europe. Metagenomic analyses revealed bacterial co-infections in both cases. Interestingly, in the Washington, DC, case, evidence is presented of the first reported Rhodococcus-influenza virus co-infection.

IMPORTANCE

This study applied modern molecular biotechnology and high-throughput sequencing to formalin-fixed, paraffin-embedded autopsy lung samples from two fatal cases during the fall wave of the 1918 influenza A (H1N1) pandemic in the United States. Complete influenza genomes were obtained from both cases, which increases the total number of available complete or near-complete influenza genomes of the 1918 pandemic virus from four to six. Sequence analysis confirms that the 1918 pandemic virus was highly conserved during the main wave of the pandemic with geographic separation in North America and Europe. Metagenomic analyses revealed bacterial co-infections in both cases, including the first reported evidence of Rhodococcus-influenza co-infection. Overall, this study offers a detailed view at the molecular level of the very limited samples from the most devastating influenza pandemic in modern human history.

An inactivated multivalent influenza A virus vaccine is broadly protective in mice and ferrets

Influenza A viruses (IAVs) present major public health threats from annual seasonal epidemics and pandemics and from viruses adapted to a variety of animals including poultry, pigs, and horses. Vaccines that broadly protect against all such IAVs, so-called "universal" influenza vaccines, do not currently exist but are urgently needed. Here, we demonstrated that an inactivated, multivalent whole-virus vaccine, delivered intramuscularly or intranasally, was broadly protective against challenges with multiple IAV hemagglutinin and neuraminidase subtypes in both mice and ferrets. The vaccine is composed of four β-propiolactone-inactivated low-pathogenicity avian IAV subtypes of H1N9, H3N8, H5N1, and H7N3. Vaccinated mice and ferrets demonstrated substantial protection against a variety of IAVs, including the 1918 H1N1 strain, the highly pathogenic avian H5N8 strain, and H7N9. We also observed protection against challenge with antigenically variable and heterosubtypic avian, swine, and human viruses. Compared to control animals, vaccinated mice and ferrets demonstrated marked reductions in viral titers, lung pathology, and host inflammatory responses. This vaccine approach indicates the feasibility of eliciting broad, heterosubtypic IAV protection and identifies a promising candidate for influenza vaccine clinical development.

Microplastic accumulation and biomagnification in a coastal marine reserve situated in a sparsely populated area

Toxic chemicals within and adsorbed to microplastics (0.05-5 mm) have the potential to biomagnify in food webs. However, microplastic concentrations in highly productive, coastal habitats are not well understood. Therefore, we quantified the presence of microplastics in a benthic community and surrounding environment of a remote marine reserve on the open coast of California, USA. Concentrations of microplastic particles in seawater were 36.59 plastics/L and in sediments were 0.227 ± 0.135 plastics/g. Densities of microplastics on the surfaces of two morphologically distinct species of macroalgae were 2.34 ± 2.19 plastics/g (Pelvetiopsis limitata) and 8.65 ± 6.44 plastics/g (Endocladia muricata). Densities were highest in the herbivorous snail, Tegula funebralis, at 9.91 ± 6.31 plastics/g, potentially due to bioaccumulation. This study highlights the need for further investigations of the prevalence and potential harm of microplastics in benthic communities at remote locations as well as human population centers.

Identification of soil bacteria capable of utilizing a corn ethanol fermentation byproduct

A commercial corn ethanol production byproduct (syrup) was used as a bacterial growth medium with the long-term aim to repurpose the resulting microbial biomass as a protein supplement in aquaculture feeds. Anaerobic batch reactors were used to enrich for soil bacteria metabolizing the syrup as the sole nutrient source over an eight-day period with the goal of obtaining pure cultures of facultative organisms from the reactors. Amplification of the V4 variable region of the 16S rRNA gene was performed using barcoded primers to track the succession of microbes enriched for during growth on the syrup. The resulting PCR products were sequenced using Illumina MiSeq protocols, analyzed via the program QIIME, and the alpha-diversity was calculated. Seven bacterial families were the most prevalent in the bioreactor community after eight days of enrichment: Clostridiaceae, Alicyclobacillaceae, Ruminococcaceae, Burkholderiaceae, Bacillaceae, Veillonellaceae, and Enterobacteriaceae. Pure culture isolates obtained from the reactors, and additional laboratory stock strains, capable of facultative growth, were grown aerobically in microtiter plates with the syrup substrate to monitor growth yield. Reactor isolates of interest were identified at a species level using the full 16S rRNA gene and other biomarkers. Bacillus species, commonly used as probiotics in aquaculture, showed the highest biomass yield of the monocultures examined. Binary combinations of monocultures yielded no apparent synergism between organisms, suggesting competition for nutrients instead of cooperative metabolite conversion.

Lisdexamfetamine dimesylate in binge eating disorder: a placebo controlled trial

OBJECTIVE

To evaluate lisdexamfetamine dimesylate (LDX) in the treatment of binge eating disorder (BED).

METHOD

Fifty participants with BED received LDX (20-70 mg/day) (n = 25) or placebo (n = 25) for up to 12 weeks in a single-center, randomized, double-blind, and flexible-dose trial. The primary outcome measure was binge eating (BE) days/week.

RESULTS

In the primary longitudinal analysis, compared with placebo, LDX was not associated with a significantly greater rate of reduction in BE days/week, as well as BE episodes/week, and scores on the Clinical Global Impression-Severity or Yale-Brown Obsessive-Compulsive Scale modified for binge eating scales. It was, however, associated with significantly decreased weight, body mass index, and fasting triglyceride level. In the secondary last observation carried forward analyses, LDX was associated with statistically significant reductions in BE days/week, BE episodes/week, weight, and BMI, as well as a statistically significant greater level of categorical response and global improvement. The mean (standard deviation) LDX daily dose at endpoint evaluation was 59.6 (14.9) mg. One participant discontinued LDX for a serious adverse cardiovascular event, which resolved fully.

CONCLUSION

Lisdexamfetamine dimesylate may have clinical utility for BED but further studies of its efficacy, tolerability, and safety in this population are needed. Copyright © 2016 John Wiley & Sons, Ltd.

It's not what you hear, it's the way you think about it: appraisals as determinants of affect and behaviour in voice hearers

BACKGROUND

Previous studies have suggested that beliefs about voices mediate the relationship between actual voice experience and behavioural and affective response.

METHOD

We investigated beliefs about voice power (omnipotence), voice intent (malevolence/benevolence) and emotional and behavioural response (resistance/engagement) using the Beliefs About Voices Questionnaire - Revised (BAVQ-R) in 46 voice hearers. Distress was assessed using a wide range of measures: voice-related distress, depression, anxiety, self-esteem and suicidal ideation. Voice topography was assessed using measures of voice severity, frequency and intensity. We predicted that beliefs about voices would show a stronger association with distress than voice topography.

RESULTS

Omnipotence had the strongest associations with all measures of distress included in the study whereas malevolence was related to resistance, and benevolence to engagement. As predicted, voice severity, frequency and intensity were not related to distress once beliefs were accounted for.

CONCLUSIONS

These results concur with previous findings that beliefs about voice power are key determinants of distress in voice hearers, and should be targeted specifically in psychological interventions.

Plant genotype and nitrogen loading influence seagrass productivity, biochemistry, and plant-herbivore interactions

Genetic variation within and among key species can have significant ecological consequences at the population, community, and ecosystem levels. In order to understand ecological properties of systems based on habitat-forming clonal plants, it is crucial to clarify which traits vary among plant genotypes and how they influence ecological processes, and to assess their relative contribution to ecosystem functioning in comparison to other factors. Here we used a mesocosm experiment to examine the relative influence of genotypic identity and extreme levels of nitrogen loading on traits that affect ecological processes (at the population, community, and ecosystem levels) for Zostera marina, a widespread marine angiosperm that forms monospecific meadows throughout coastal areas in the Northern Hemisphere. We found effects of both genotype and nitrogen addition on many plant characteristics (e.g., aboveground and belowground biomass), and these were generally strong and similar in magnitude, whereas interactive effects were rare. Genotypes also strongly differed in susceptibility to herbivorous isopods, with isopod preference among genotypes generally matching their performance in terms of growth and survival. Chemical rather than structural differences among genotypes drove these differences in seagrass palatability. Nitrogen addition uniformly decreased plant palatability but did not greatly alter the relative preferences of herbivores among genotypes, indicating that genotype effects are strong. Our results highlight that differences in key traits among genotypes of habitat-forming species can have important consequences for the communities and ecosystems that depend on them and that such effects are not overwhelmed by known environmental stressors.

What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour--and are they the same?

There is convincing evidence that targeting self-efficacy is an effective means of increasing physical activity. However, evidence concerning which are the most effective techniques for changing self-efficacy and thereby physical activity is lacking. The present review aims to estimate the association between specific intervention techniques used in physical activity interventions and change obtained in both self-efficacy and physical activity behaviour. A systematic search yielded 27 physical activity intervention studies for 'healthy' adults that reported self-efficacy and physical activity data. A small, yet significant (P < 0.01) effect of the interventions was found on change in self-efficacy and physical activity (d = 0.16 and 0.21, respectively). When a technique was associated with a change in effect sizes for self-efficacy, it also tended to be associated with a change (r(s) = 0.690, P < 0.001) in effect size for physical activity. Moderator analyses found that 'action planning', 'provide instruction' and 'reinforcing effort towards behaviour' were associated with significantly higher levels of both self-efficacy and physical activity. 'Relapse prevention' and 'setting graded tasks' were associated with significantly lower self-efficacy and physical activity levels. This meta-analysis provides evidence for which psychological techniques are most effective for changing self-efficacy and physical activity.

Organ-specific shifts in mtDNA heteroplasmy following systemic delivery of a mitochondria-targeted restriction endonuclease

Most pathogenic mtDNA mutations are heteroplasmic and there is a clear correlation between high levels of mutated mtDNA in a tissue and pathology. We have found that in vivo double strand breaks (DSB) in mtDNA lead to digestion of cleaved mtDNA and replication of residual mtDNA. Therefore, if DSB could be targeted to mutations in mtDNA, mutant genomes could be eliminated and the wild-type mtDNA would repopulate the cells. This can be achieved by using mitochondria-targeted restriction endonucleases as a means to degrade specific mtDNA haplotypes in heteroplasmic cells or tissues. In the present work we investigated the potential of systemic delivery of mitochondria-targeted restriction endonucleases to reduce the proportion of mutant mtDNA in specific tissues. Using the asymptomatic NZB/BALB mtDNA heteroplasmic mouse as a model, we found that a mitochondria-targeted ApaLI (that cleaves BALB mtDNA at a single site and does not cleave NZB mtDNA) increased the proportion of NZB mtDNA in target tissues. This was observed in heart, using a cardiotropic adeno-associated virus type-6 (AAV6) and in liver, using the hepatotropic adenovirus type-5 (Ad5). No mtDNA depletion or loss of cytochrome c oxidase activity was observed in any of these tissues. These results demonstrate the potential of systemic delivery of viral vectors to specific organs for the therapeutic application of mitochondria-targeted restriction enzymes in mtDNA disorders.

Modulating mtDNA heteroplasmy by mitochondria-targeted restriction endonucleases in a 'differential multiple cleavage-site' model

The ability to manipulate mitochondrial DNA (mtDNA) heteroplasmy would provide a powerful tool to treat mitochondrial diseases. Recent studies showed that mitochondria-targeted restriction endonucleases can modify mtDNA heteroplasmy in a predictable and efficient manner if it recognizes a single site in the mutant mtDNA. However, the applicability of such model is limited to mutations that create a novel cleavage site, not present in the wild-type mtDNA. We attempted to extend this approach to a 'differential multiple cleavage site' model, where an mtDNA mutation creates an extra restriction site to the ones normally present in the wild-type mtDNA. Taking advantage of a heteroplasmic mouse model harboring two haplotypes of mtDNA (NZB/BALB) and using adenovirus as a gene vector, we delivered a mitochondria-targeted Scal restriction endonuclease to different mouse tissues. Scal recognizes five sites in the NZB mtDNA but only three in BALB mtDNA. Our results showed that changes in mtDNA heteroplasmy were obtained by the expression of mitochondria-targeted ScaI in both liver, after intravenous injection, and in skeletal muscle, after intramuscular injection. Although mtDNA depletion was an undesirable side effect, our data suggest that under a regulated expression system, mtDNA depletion could be minimized and restriction endonucleases recognizing multiple sites could have a potential for therapeutic use.

Efficacy of methylenecyclopropane analogs of nucleosides against herpesvirus replication in vitro

We have reported previously that purine methylenecyclopropane analogs are potent agents against cytomegaloviruses. In an attempt to extend the activity of these compounds, the 2-amino-6-cyclopropylaminopurine analog, QYL-1064, was selected for further study by modifying the purine 6 substituent. A total of 22 analogs were tested against herpes simplex virus types 1 and 2 (HSV-1, HSV-2), varicella zoster virus (VZV), human cytomegalovirus (HCMV), murine cytomegalovirus (MCMV), Epstein-Barr virus (EBV), human herpesvirus type 6 (HHV-6) and human herpesvirus type 8 (HHV-8). Ten of the analogs had activity against at least one of the viruses tested. One compound had moderate activity against HSV-1 and six had activity against VZV. All but one compound was active against HCMV with a mean EC50 of 2.1 +/- 0.6 microM, compared with a mean EC50 of 3.9 +/- 0.8 microM for ganciclovir. Of special interest was the fact that eight of the ten compounds were active against both HHV-6A and HHV-6B with mean EC50 values of 6.0 +/- 5.2 mciroM and <2.4 +/- 1.5 microM, respectively. Only two compounds had activity against EBV, whereas all but one compound was active against HHV-8 with a mean EC50 of 3.1 +/- 1.7 microM. These results indicate that members of this series of methylenecyclopropane analogs are highly active against HCMV, HHV-6, and HHV-8 but are less active against HSV, VZV, and EBV.

In vitro activities of benzimidazole D- and L-ribonucleosides against herpesviruses

Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), and human herpesvirus 8 (HHV-8) are responsible for a number of clinical manifestations in both normal and immunocompromised individuals. The parent benzimidazole ribonucleosides evaluated in this series, 2-bromo-5,6-dichloro-1-(beta-D-ribofuranosyl)benzimidazole (BDCRB) and maribavir (1263W94), are potent and selective inhibitors of human CMV replication. These nucleosides act by two different mechanisms. BDCRB blocks the processing and maturation of viral DNA, whereas 1263W94 inhibits the viral enzyme pUL97 and interferes with DNA synthesis. In the present study, we have evaluated the in vitro antiviral activity of BDCRB, an analog, GW275175X (175X), and 1263W94 against the replication of HSV-1, HSV-2, VZV, CMV, EBV, HHV-6, and HHV-8. By using various methodologies, significant activity was observed against human CMV and EBV but not against HSV-1, HSV-2, VZV, HHV-6, or HHV-8. Plaque reduction assays performed on a variety of laboratory and clinical isolates of human CMV indicated that all strains, including those resistant to ganciclovir (GCV) and foscarnet, were sensitive to all three benzimidazole ribonucleosides, with mean 50% effective concentration values of about 1 to 5 microM compared to that of GCV at 6 microM. The toxicity of these compounds in tissue culture cells appeared to be similar to that observed with GCV. These results demonstrate that the benzimidazole ribonucleosides are active against human CMV and EBV and suggest that they may be useful for the treatment of infections caused by these herpesviruses.

Determination of antiviral efficacy against lymphotropic herpesviruses utilizing flow cytometry

Epstein-Barr virus (EBV), human herpesvirus type 6 (HHV-6), and human herpesvirus type 8 (HHV-8) comprise a group of lymphotropic herpesviruses which are responsible for a wide range of diseases, including lymphoproliferative disorders and tumors. We have developed several flow cytometric assay (FACS) systems to evaluate antiviral efficacy against EBV, HHV-6 and HHV-8. Assays using either EBV or HHV-8, members of the gammaherpesvirus subfamily, have shown that while EBV responds well to acyclovir (ACV), HHV-8 was most sensitive to cidofovir (CDV). Since HHV-6 strains are divided into two sub-groups, A and B, we evaluated antiviral efficacy for strains from each group. The group A strain, HHV-6(GS), was inhibited by foscarnet (PFA), CDV and ganciclovir (GCV) in both Sup-T1 and HSB-2 cell lines. HHV-6(Z-29), a representative group B virus, was inhibited by GCV and CDV but not by PFA. Our findings indicate that flow cytometry can be utilized to efficiently evaluate new antiviral agents against lymphotropic herpesviruses and that the results are comparable to those obtained by other methods such as immunofluorescence.

The enantiomers of carbocyclic 5'-norguanosine: activity towards Epstein-Barr virus

(-)-5'-noraristeromycin (1) has shown antiviral activity towards, particularly cytomegalovirus, vaccinia virus and measles while its (+)-enantiomer (2) is effective towards hepatitis B virus. To determine if the antiviral characteristics of 1 and 2 extended to the guanine analogues (3 and 4), these enantiomers were prepared and evaluated against herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), cytomegalovirus (CMV), varicella zoster virus (VZV), Epstein-Barr virus (EBV), human herpes virus type 6 (HHV-6), human herpes virus type 8 (HHV-8), vaccinia virus (VV), cowpox virus (CV), vesicular stomatitis virus (VSV), respiratory syncytial virus (RSV), hepatitis B virus (HBV), and human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2). The only activity found for 3 was for Epstein-Barr virus in VCA Elisa (EC50 0.78 microg/mL), immunofluorescence assay for VCA or gp 350/250 (1.8-4.0 microg/mL) and DNA hybridization (EC50 0.82 microg/mL) assays with no accompanying toxicity seen in the host Daudi cells. No activity was noted for 4.

Immunological phenotyping of fibroblast cultures from patients with a mitochondrial respiratory chain deficit

Conventional approaches to the diagnosis of mitochondrial respiratory chain diseases, using enzyme assays and histochemistry, are laborious and give limited information concerning the genetic basis of a deficiency. We have evaluated the diagnostic value of 12 monoclonal antibodies to subunits of the four respiratory chain enzyme complexes and F(1)F(0)-ATP synthase. Antibodies were used in immunological studies with skin fibroblast cultures derived from patients with diverse mitochondrial diseases, including patients in which the disease was caused by a nuclear genetic defect and patients known to harbor a heteroplasmic mutation in a mitochondrial tRNA gene. Immunoblotting experiments permitted the identification of specific enzyme assembly deficits and immunocytochemical studies provided clues regarding the genetic origin of the disease. The immunological findings were in agreement with the biochemical and genetic data of the patients. Our study demonstrates that characterization of the fibroblast cultures with the monoclonal antibodies provides a convenient technique to complement biochemical assays and histochemistry in the diagnosis of mitochondrial respiratory chain disorders.

Assembly of cytochrome c oxidase: what can we learn from patients with cytochrome c oxidase deficiency?

Cytochrome c oxidase is an intricate metalloprotein that transfers electrons from cytochrome c to oxygen in the last step of the mitochondrial respiratory chain. It uses the free energy of this reaction to sustain a transmembrane electrochemical gradient of protons. Site-directed mutagenesis studies of bacterial terminal oxidases and the recent availability of refined crystal structures of the enzyme are rapidly expanding the understanding of the coupling mechanism between electron transfer and proton translocation. In contrast, relatively little is known about the assembly pathway of cytochrome c oxidase. Studies in yeast have indicated that assembly is dependent on numerous proteins in addition to the structural subunits and prosthetic groups. Human homologues of a number of these assembly factors have been identified and some are now known to be involved in disease. To dissect the assembly pathway of cytochrome c oxidase, we are characterizing tissues and cell cultures derived from patients with genetically defined cytochrome c oxidase deficiency, using biochemical, biophysical and immunological techniques. These studies have allowed us to identify some of the steps of the assembly process.

A novel mutation in SURF1 causes skipping of exon 8 in a patient with cytochrome c oxidase-deficient leigh syndrome and hypertrichosis

Leigh syndrome is a rare pediatric neurodegenerative disorder attributed to impaired mitochondrial energy metabolism. Mutations in SURF1 have been described in several patients with Leigh syndrome associated with cytochrome c oxidase deficiency. We report a new 18-bp deletion (821del18), spanning the splice donor junction of exon 8 of SURF1, in an infant presenting with cytochrome c oxidase-deficient Leigh syndrome and hypertrichosis. cDNA sequencing demonstrated that this deletion results in a messenger lacking exon 8. RT-PCR experiments suggested a rapid degradation of the aberrant mRNA species from the 5'-end.

Effects of physical and biological disturbances on algal turfs in Kaneohe Bay, Hawaii

Disturbance in coral reef environments commonly results in an algal community dominated by highly productive, small filamentous forms and cyanobacteria, collectively known as algal turf. Research on the types of disturbance responsible for this community structure has concentrated mainly on biological disturbance in the form of grazing, although physical and other forms of biological disturbances may be important in many coral reef areas. On the reef flat in Kaneohe Bay, Oahu, Hawaii, algal turfs grow primarily upon coral rubble that tumbles with passing swells. We manipulated the frequency of rubble tumbling in field experiments to mimic the effects of physical disturbance by abrasion and light reduction on algal biomass, canopy height, and community structure. Treatments approximated a gradient of disturbance intensities and durations that occur on the reef flat. Although sea urchins and herbivorous fishes are not widespread and abundant on the reef flat, biological disturbances to algal turf communities in the form of herbivory by small crabs and abrasion by tough macroalgae contributed significantly to the variation in algal turf biomass. Within all experiments increasing disturbance significantly reduced algal biomass and canopy heights and the community structure shifted to more disturbance-tolerant algal forms. This study shows that the chronic physical disturbances from water motion and biological disturbances other than grazing from large herbivores can control algal communities in coral reef environments.

Methylene blue based protein solder for vascular anastomoses: an in vitro burst pressure study

BACKGROUND AND OBJECTIVE

Attempts at sutureless anastomoses have used protein-based solders containing chromophores [Oz et al., J Vasc Surg 1990;11:718; Poppas et al., J Urol 1998150:1052] to enhance the strength of laser anastomoses. Reports have described the use of indocyanine green [Oz et al., Surg Forum 1989;316.], fuschin, and fluorescein isothiocyanate as chromophores [Chuck et al. , Lasers Surg Med 1989;9:471; Vance et al., Lasers Med Sci 1988;3:219]. Methylene blue (MB) is a chromophore with absorption peaks in the 600-700 nm region whose use has not been reported in laser-assisted vascular anastomoses. Therefore, we set out to produce and characterise a MB-containing protein solder. The absorption and burst pressure characteristics have been investigated and described as well as a brief review of the chemical and biological properties of MB.

STUDY DESIGN/MATERIALS AND METHODS

The MB and porcine serum albumin (PSA)-based solder was produced and used to form end-to-end anastomoses in porcine splenic arteries. The solder was activated using a laser diode emitting at 670 nm. The burst pressures of the anastomoses were tested, and the results analysed as a function of MB concentration and absorption. In addition, the relationship between MB concentration and absorption was examined.

RESULTS

A dose-response relationship was found between the measured absorption of the solder and the burst pressure of the anastomoses formed. Burst pressures exceeding physiological levels were found. Changes in MB concentration revealed a marked negative deviation from Beer's law at 670 nm, owing to the monomer-dimer-trimer equilibria.

CONCLUSION

PSA with MB solder is able to form high-quality end-to-end anastomoses, with immediate burst pressure profiles similar to those previously described for sutured [Quigley et al., Microsurgery 1985;6:229], lasered [Quigley et al., Microsurgery 1985;6:229], and soldered anastomoses [Small et al., J Clin Laser Med Surg 1997;15:205]. The relationship between burst pressure strength and chromophore absorption is discussed.

Vocal expression of anger and cardiovascular reactivity within dyadic interactions

This experiment was conducted to examine whether the vocal expression of anger correlated with cardiovascular reactivity within dyadic interactions. Participants selected three social issues on which they had a strong opinion and, with a confederate who opposed their views, debated these opinions in each of the three vocal styles. The three vocal styles were (1) Anger-out during which they described their view in a loud, fast voice, (2) Mood-incongruent during which they described their view in a soft, slow voice, and (3) Anger-in during which they listened to the confederate oppose their view and only responded from a list of neutral phrases given to them. Cardiovascular reactivity measures (heart rate and blood pressure) were taken during the initial baseline and the three expression of anger conditions. Both the anger-out and mood-incongruent vocal styles significantly correlated with systolic blood pressure and heart-rate reactivity measures. The disparity between the results of this experiment and previous ones on anger and cardiovascular response may be related to differences in the method of anger-arousal (memory-evoked versus dyadic interactions). Results are discussed in terms of similarities to active and passive coping and defensiveness.

Development of a firefly luciferase-based assay for determining antimicrobial susceptibility of Mycobacterium avium subsp. paratuberculosis

Paratuberculosis (Johne's disease) is a fatal disease of ruminants for which no effective treatment is available. Presently, no drugs against Mycobacterium avium subsp. paratuberculosis (M. paratuberculosis), the causative agent of Johne's disease, are approved for use in livestock. Additionally, M. paratuberculosis has been linked to a human chronic granulomatous ileitis (Crohn's disease). To assist in the evaluation of antimicrobial agents with potential activity against M. paratuberculosis, we have developed a firefly luciferase-based assay for the determination of drug susceptibilities. The microorganism used was M. paratuberculosis K-10(pYUB180), a clinical isolate carrying a plasmid with the firefly luciferase gene. The MICs determined by the broth macrodilution method were as follows: amikacin, 2 microg/ml; Bay y 3118, 0.015 microg/ml; clarithromycin, 1.25 microg/ml; D-cycloserine, 25 microg/ml; ethambutol, 20 microg/ml; and rifabutin, 0.5 microg/ml. The strain was resistant to isoniazid and kanamycin. The results obtained by the luciferase assay were identical or fell within 1 doubling dilution. These results suggest that a combination of amikacin, clarithromycin, and rifabutin may be the most efficacious therapy for the treatment of M. paratuberculosis infections and that the use of fluoroquinolone class of antibiotics deserves further consideration. We demonstrate that the luciferase drug susceptibility assay is reliable for M. paratuberculosis and gives results within 7 days, whereas the broth macrodilution method requires 14 days.

An independent evaluation of the Age-Related Eye Disease Study (AREDS) cataract grading system

PURPOSE

To assess intra- and interobserver reproducibility of the Age-Related Eye Disease Study (AREDS) system for grading lens opacities and to provide data on its capacity to reliably detect changes in lens status.

METHODS

Independent and replicate grading of 40 sets of lens photographs (one slit-lamp and two retroillumination photographs) were performed by three experienced observers. Patients were participants in the Collaborative Italian-American Clinical Trial of Nutritional Supplements which is testing the effect of a mineral-multivitamin supplement on age-related cataract (CTNS). Scatterplots and intraclass correlation were used to assess measurement error.

RESULTS

Analysis revealed good intra- and interobserver reproducibility of the system. Greatest intraobserver measurement error showed 100% of pairs within 10% areal difference for cortical cataract, 97.5% within 15% areal difference for posterior subcapsular cataract, and 100% within 1 density unit difference for nuclear opacity. Greatest interobserver measurement error showed 95% of pairs within 10% areal difference for cortical cataract, 97.5% within 15% areal difference for posterior subcapsular cataract, and 97.5% within 1.5 density unit difference for nuclear opacity.

CONCLUSIONS

The AREDS lens opacities grading system appears to be sufficiently reliable to detect changes of at least 10% areal involvement for cortical, 15% areal involvement for posterior subcapsular, and 1.0 units for nuclear opacities. It therefore seems sufficiently sensitive to adequately monitor progression of lens opacities in a longitudinal study of patients with early cataract. Its applicability in a population with advanced or complex mixed opacities must await further testing.

Thoughts of agoraphobic people during scary tasks

The authors examined the occurrence of theoretically derived patterns of thinking in 74 agoraphobic participants as they drove alone or tolerated an enclosed place. During the increasingly scary tasks in a behavioral test hierarchy, participants responded to a periodic beep by stating aloud what they were thinking at that moment, yielding more than 1,800 tape-recorded statements. Content analyses revealed that participants were mainly preoccupied with their current anxiety (expressed in 29% of the statements) and with their self-efficacy (15%). Despite participants' mounting feelings of anxiety, fewer than 1% of their statements expressed a thought of danger or an anticipation of future anxiety or panic. The rarity of danger thoughts poses an explanatory challenge for all cognitive theories of phobia and especially for the perceived danger theory of A. T. Beck (1976) and A. T. Beck, G. Emery, and R. L. Greenberg (1985).

Thoughts of agoraphobic people during scary tasks

The authors examined the occurrence of theoretically derived patterns of thinking in 74 agoraphobic participants as they drove alone or tolerated an enclosed place. During the increasingly scary tasks in a behavioral test hierarchy, participants responded to a periodic beep by stating aloud what they were thinking at that moment, yielding more than 1,800 tape-recorded statements. Content analyses revealed that participants were mainly preoccupied with their current anxiety (expressed in 29% of the statements) and with their self-efficacy (15%). Despite participants' mounting feelings of anxiety, fewer than 1% of their statements expressed a thought of danger or an anticipation of future anxiety or panic. The rarity of danger thoughts poses an explanatory challenge for all cognitive theories of phobia and especially for the perceived danger theory of A. T. Beck (1976) and A. T. Beck, G. Emery, and R. L. Greenberg (1985).

The effects of human macrophage inflammatory protein-1 alpha and its genetically modified variant, BB10010, on phagocyte function

BB-10010 is a genetically modified form of human macrophage inflammatory protein-1 alpha (MIP-1 alpha) with a single amino acid substitution of Asp26 by alanine, which inhibits aggregation of the native molecule. BB-10010 has stem cell protective properties, and has entered clinical trials for this purpose. The aim of this study was to determine the effects of BB-10010 on human phagocyte function and compare them with the native molecule. MIP-1 alpha and BB-10010 had identical dose-response curves in assays of calcium mobilization; however, neutrophils were less sensitive than monocytes to either MIP-1 alpha form, suggesting differences in receptor expression. Neither MIP-1 alpha type directly stimulated phagocyte superoxide production, nor did it have any priming effect on agonist-induced superoxide production. Both MIP-1 alpha and BB-10010 enhanced monocyte migration; however, cells were more sensitive to the native molecule, with optimal effects seen at 1 ng/ml compared with 100 ng/ml BB-10010. Concomitant alteration of CD11b, CD18, and CD49d (VLA-alpha 4) cell adhesion molecule expression was not seen with either MIP-1 alpha type. With the exception of the difference in monocyte sensitivity in chemotaxis assays, BB-10010 reproduces the effects of the native molecule on phagocytes. BB-10010 does not have proinflammatory effects on neutrophil activation, and this bodes well for its clinical use.

The activity of rifabutin against Mycobacterium leprae in armadillos

The activity of rifabutin (LM 427) against Mycobacterium leprae was evaluated in armadillos inoculated earlier with human-derived M. leprae. Rifabutin was administered daily at a dose of 6 mg/kg body weight/day. The effect of rifabutin on M. leprae harvested from armadillos was determined by measuring the intracellular levels of ATP (an indicator of metabolic activity) of M. leprae and also their ability to multiply in the mouse footpads and in vitro in DH medium. Within 2 weeks of initiating the treatment, ATP levels declined to 21% of the original (pre-treatment level) and these M. leprae failed to multiply in the footpads of mice as well as in the in vitro culture system. This suggests that rifabutin was able to kill all M. leprae within 2 weeks. After 8 weeks the treatment was terminated and results showed that M. leprae from the treated armadillos remained non-viable in the mouse footpad system as well as in the in vitro system, indicating bactericidal action of rifabutin. The results suggest that rifabutin can be a substitute for rifampin in the leprosy multi-drug therapy regimen.

Lower third molar treatment planning ability of general dental practitioners and oral maxillofacial surgeons using receiver operating characteristics methodology

A comparison of lower third molar treatment planning ability of six oral and maxillofacial surgeons (three consultants, two senior registrars and one senior house officer) and 27 general dental practitioners was carried out using Receiver Operating Characteristics (ROC) methodology. Each clinician was presented with the same series of 50 case histories and asked to indicate, using a rating scale, how certain they were that each lower third molar required removal. These data, together with NIH gold standard treatment decisions for each third molar, were then used to construct ROC curves for each clinician and, using combined data, to produce ROC curves for the groups of hospital specialists and general dental practitioners. These curves were then compared statistically. There were significant differences between the best and worst practitioners, both in the hospital service and within general dental practice. When combined data were examined, however, there was no statistical difference in the treatment planning ability of hospital specialists and general dental practitioners. These findings indicate that lower third molar treatment planning ability is more dependent upon individual factors than specialist training. Further, the data presented here suggest that general dental practitioners are as capable of treatment planning for lower third molars as the specialists to whom they refer.

A functional model of nerve repair. Reanastomosis vs entubulation repair

OBJECTIVE

To compare reanastomosis and entubulation repair after transection of the peroneal nerve in rats with the use of 2 functional models: gait analysis and a tension transduction device.

DESIGN

Prospective, randomized, blinded control study. Each animal served as its own control. The injured site was alternated between the left and the right. Gait analysis was evaluated in a blind fashion at postoperative weeks 1, 3, 7, and 13, and the tension transduction device at week 13, for injured and uninjured legs.

SUBJECTS

Animals underwent unilateral peroneal nerve transection injury, half with entubulation and half with end-to-end reanastomosis repair.

INTERVENTION

Nerve transection was performed 6 mm proximal to the anterior tibialis muscle insertion followed by reanastomosis (epineurial suture placement to align the sectioned nerve ends) or entubulation (placement of nerve ends into a 4-mm-long sterile Silastic tube secured with 2 epineurial sutures).

RESULTS

Gait analysis demonstrated a poorer ankle angle in all injured legs compared with uninjured legs at each postoperative period. Ankle angles for reanastomosis were statistically better than those for entubulation at weeks 3, 7, and 13. The tension transduction device demonstrated poorer force in injured than uninjured animals at 13 weeks. Reanastomosis repair groups demonstrated no difference in force development compared with entubulation repair groups.

CONCLUSIONS

Reanastomosis of the transected rat peroneal nerve demonstrated improved functional return by gait analysis when compared with entubulation-repaired nerves at postoperative weeks 3, 7, and 13. Force development of injured nerve groups measured by the tension transduction device was decreased compared with control, but no difference was detected between the 2 repair methods. Further studies are needed to evaluate the possible functional benefit of reanastomosis.

Hyperbaric Oxygen Treatment after rat Peroneal Nerve Transection and Entubulation

Rat peroneal nerves were transected and entubulated with a Silastic channel. The experimental group was treated with hyperbaric oxygen to evaluate changes in acute edema, functional recovery, and histology. Hyperbaric oxygen was administered with 100% O2 at 2.5 atmospheres absolute for 90 minutes twice a day for 1 week and then four times a day for 1 week. Acute edema changes based on nerve water weight and transfascicular area measurements were greater in injured than in uninjured nerves but demonstrated no differences between hyperbaric oxygen–treated and –untreated groups 2, 8, and 16 days after surgery. Functional evaluation with gait analysis demonstrated significant changes between injured and uninjured groups 1,3,7, and 13 weeks after injury but no differences between hyperbaric oxygen-treated and –untreated groups. Thirteen weeks after the initial injury, elicited muscle force measurements demonstrated no significant improvement from hyperbaric oxygen treatment of injured nerves. Histologic evaluation of nerve area, myelinated axon number, myelinated axon area, myelin thickness, and blood vessel number and area revealed no significant differences between hyperbaric oxygen–treated and –untreated groups. Hyperbaric oxygen was not associated with improvement of nerve regeneration with any of the outcome variables in this model.

Cognitive and performance-based treatments for panic attacks in people with varying degrees of agoraphobic disability

Compared the effectiveness of cognitive therapy and performance-based exposure as treatments for panic attacks. Subjects were 48 panicky individuals selected without regard to agoraphobic disability, and who varied widely in that respect. Subjects were assigned randomly to either cognitive treatment, performance-based exposure treatment, a combined cognitive/performance treatment, or a no-treatment control condition. All three treatments led to marked and enduring improvements in panic, and did not differ from one another in effectiveness, whereas the control condition produced little benefit. However, on several measures of phobia and panic-related cognitions, performance exposure was significantly more effective than cognitive therapy. Degree of agoraphobic disability had a significant bearing on panic treatment effectiveness. Whereas 94% of the low agoraphobia Ss were free of panic after treatment, only 52% of the high agoraphobia Ss became panic-free. The findings suggest that when panic treatment research excludes people with serious phobias, as it has routinely done in recent years, an overly positive estimate of panic treatment effectiveness can result.

The regulation of neutrophil phospholipase A2 by granulocyte-macrophage colony-stimulating factor and its role in priming superoxide production

Experiments were performed to investigate the relative role of phospholipase A2 (PLA2) in the activation and cytokine-mediated priming of neutrophil superoxide production. PLA2 activity was measured with a radiometric assay which discriminates between PLA2 and the downstream enzyme, 5-lipoxygenase. In cells that had not been primed by prior incubation with granulocyte-macrophage colony stimulating factor (GM-CSF), PLA2 and NADPH oxidase were differentially stimulated by the chemotactic peptide N-formyl-met-leu-phe (FMLP), calcium ionophore, or phorbol ester. In addition, inhibition of PLA2 by mepacrine (0-100 micromol/l) did not concomitantly inhibit FMLP-stimulated superoxide production. These findings suggest that the activity of PLA2 and NADPH oxidase may be uncoupled in the unprimed cell. In cells preincubated with GM-CSF, time- and dose-dependent priming of FMLP-stimulated PLA2 responses were observed and inhibition of PLA2 by mepacrine was accompanied by the inhibition of FMLP-stimulated superoxide production down to the level of unprimed cells. The effect of mepacrine was not due to inhibition of FMLP receptor expression. These data suggest that a mepacrine-sensitive PLA2 may have a role in the GM-CSF mediated priming of superoxide production. Using ionophore-stimulated PLA2 activity as a model, we showed that Bordatella pertussis toxin did not inhibit GM-CSF mediated priming, demonstrating that a pertussis-sensitive GTP-binding protein does not mediate signal transduction from the GM-CSF receptor to PLA2. The tyrosin kinase inhibitor, genestein, selectively inhibited GM-CSF primed but not unprimed PLA2 activity, demonstrating that GM-CSF-mediated priming requires tyrosine kinase activity.

Hyperbaric oxygen treatment after rat peroneal nerve transection and entubulation

Rat peroneal nerves were transected and entubulated with a Silastic channel. The experimental group was treated with hyperbaric oxygen to evaluate changes in acute edema, functional recovery, and histology. Hyperbaric oxygen was administered with 100% O2 at 2.5 atmospheres absolute for 90 minutes twice a day for 1 week and then four times a day for 1 week. Acute edema changes based on nerve water weight and transfascicular area measurements were greater in injured than in uninjured nerves but demonstrated no differences between hyperbaric oxygen-treated and -untreated groups 2, 8 and 16 days after surgery. Functional evaluation with gait analysis demonstrated significant changes between injured and uninjured group 1, 3, 7, and 13 weeks after injury but no differences between hyperbaric oxygen-treated and -untreated groups. Thirteen weeks after the initial injury, elicited muscle force measurements demonstrated no significant improvement from hyperbaric oxygen treatment of injured nerves. Histologic evaluation of nerve area, myelinated axon number, myelinated axon area, myelin thickness, and blood vessel number and area revealed no significant differences between hyperbaric oxygen-treated and -untreated groups. Hyperbaric oxygen was not associated with improvement of nerve regeneration with any of the outcome variables in this model.

A quantitative cytological study of lesional and non-lesional mucosa in oral lichen planus

Smears of buccal mucosa, dorsal surface of the tongue and floor of mouth were taken from 10 patients with histologically confirmed oral lichen planus and 12 healthy age- and sex-matched controls. In buccal smears, no significant differences in cytoplasmic and nuclear areas were observed between lesional, adjacent non-lesional and control tissues. However, the cytoplasmic area in smears from lichen planus lesions on the dorsum of the tongue and adjacent clinically normal mucosa was reduced compared with healthy controls. The cytoplasmic: nuclear ratio in smears from clinically normal floor of mouth in oral lichen planus was similarly reduced. Papanicolaou-stained smears from buccal lichen planus showed increased keratinization compared with normal buccal mucosa. These findings demonstrate that quantitative cytology can detect both cytoplasmic and nuclear changes in oral lichen planus.

Peroneal motor nerve crush injury and hyperbaric oxygen effect

The potential therapeutic effect of hyperbaric oxygen (HBO) after rat peroneal nerve crush was evaluated. Animals were given 100% oxygen at 2.5 atmosphere absolute for 90 minutes twice daily for 1 week and then once daily for 1 week. Edema increased in crushed nerves compared with control nerves, but no effect was associated with the administration of HBO. Gait analysis demonstrated injury at 1, 7, and 14 days after nerve crush, but no difference was found at 22 and 28 days after injury (analysis of variance: P < .001, 10 animals per group). Eight weeks after injury, nerve stimulation and muscle force measurements were 114 g for the injured group and 146 g for the control group (P < .001). There were no HBO-associated changes in gait parameter or nerve/muscle force measurements. This study demonstrated that rat peroneal nerve crush injury causes acute intraneural edema and temporary decrement of gait parameters. Elicited nerve stimulation demonstrated persistent loss of force 4 weeks after normalization of gait, but no HBO effect.

Neuromuscular evaluation using rat gait analysis

We have developed a rat gait analysis model to evaluate if ankle angle and other associated gait parameters could consistently define normal peroneal nerve and anterior tibialis muscle function. The second part of the study was designed to determine if such a model would be useful to measure recovery of function after a peroneal nerve crush injury (NCI). A clear plexiglas tunnel was designed for high-speed frame videotaping and subsequent computergraphic gait measurement and analysis. Normal gait patterns for ankle angle, back height, step and stride lengths and the stance and swing times were determined in 8 rats. Data analysis demonstrated no significant left/right differences for any of the variables (ANOVA) with the exception of step length. Subsequently, 12 rats with a peroneal NCI were evaluated. All gait parameters evaluated from the injured side were significantly different from the uninjured side after injury except stride length. Ankle angle was the most sensitive outcome variable. Weekly gait analysis provided objective measurements as the ankle angle gradually returned to normal within 3 weeks. The rat gait model is a sensitive and reproducible method for non-invasive evaluation of neuromuscular function during nerve recovery after a peroneal crush injury.

Tension transduction device for functional evaluation of the rat peroneal nerve

Current techniques for evaluating animal model nerve regeneration lack accurate, sensitive and reproducible methods to determine neuromuscular function. We have developed a tension transduction apparatus which measures the magnitude of ankle dorsiflexion produced by normal rats during bipolar stimulation of the surgically exposed peroneal nerve. Three groups of animals were used to evaluate the consistency and overall reliability of this apparatus. Within the first group of 4 animals, we determined variability in a single testing period of 8 successive stimulations. The mean normalized standard deviation of dorsiflexion tension produced was 2.9% of the mean. In the second group, comparison of right and left dorsiflexion tension in 8 animals showed a difference of less than 2% (right: 134.2 g; left: 131.6 g), demonstrating that one lower limb can be used as a control for the contralateral limb. In the third group, 12 animals were tested on two separate occasions, 2 months apart, tension production increased 10% (from 122 to 134 g) and corresponded with an average weight increase, per animal, of 100 g (30%) during the 2-month rest period. Despite the increase in weight and strength, the initial procedure had a negative effect upon the maximum tension produced compared to a previously unoperated leg (prior operation: 134 g; no prior operation: 144 g). The reproducibility of data obtainable with this new device allows for its incorporation in future studies, as well as the correlation of such functional data with other current methods of studying nerve regeneration.

Two-staged breast reconstruction in patients with symptomatic macromastia requiring mastectomy

Patients with symptomatic macromastia undergoing mastectomy for the treatment of malignant breast disease are candidates for a two-staged operation resulting in breast reconstruction and contralateral breast reduction. Five patients with symptomatic macromastia underwent a skin-sparing mastectomy for breast disease using a modified Wise incision. The first stage of the breast reconstruction was performed with a de-epithelialized transverse rectus abdominis musculocutaneous (TRAM) flap. Second-stage breast reconstruction was conducted 4 to 6 months later when revision of the TRAM reconstructed breast and concurrent contralateral breast reduction were performed with the intent of tailoring the reduced breast to approximate the revised TRAM breast mound. Excess areola from the reduced breast was harvested and used as a full-thickness graft to reconstruct the TRAM areola complex. Patients followed for 5 to 30 months postoperatively confirm resolution of macromastia symptoms, correction of the mastectomy defect, and symmetrical breast mound creation in a timely two-staged procedure. The two-staged breast reconstruction described represents an expedient plan for patients with symptomatic macromastia requiring mastectomy for breast disease. Skin-sparing mastectomy, modified Wise pattern incisions, utilization of usually discarded areola tissue, and creation of symmetrical breast mounds during the second stage of the reconstruction highlight the salient features of this patient management paradigm.

The pediatric patient in the post anesthesia care unit

This article provides an overview of pediatric post anesthesia care. It highlights important aspects of care that are frequently encountered in practice or have the potential for being problematic. These include airway management, fluid maintenance, the treatment of seizures, thermoregulation, the management of malignant hyperthermia, the identification and treatment of emergence delirium, and the availability of appropriate emergency equipment and medications.

Partial mastectomy and breast reduction as a valuable treatment option for patients with macromastia and carcinoma of the breast

The essential goals of every reconstructive procedure of the breast are to create a breast mound and establish symmetry. Breast conservation operation is now a widely accepted treatment for carcinoma of the breast. Four patients who presented with macromastia or mammary hypertrophy and a simultaneous carcinoma of the breast were treated by combined partial mastectomy and bilateral breast reduction. Incisions on the breast were made using standard Wise pattern (keyhole) markings. In each instance, the tumor was removed with a generous margin of normal surrounding mammary tissue. Two procedures used the inferior pedicle technique and two were done by resection and transplantation of the nipple. The average mammary tissue resection was 825 grams. All incisions healed primarily and necessary adjuvant chemoradiation was not delayed. Each patient is alive and well without evidence of disease with a follow-up period ranging from seven to 43 months. Postoperatively, the appearance of the breast is esthetically improved and all symptoms related to macromastia have resolved. Advantages of combining these two techniques include improved symmetry, easier postoperative self-examination of the breast and decreased radiation effect noted with larger breasts. Postoperative mammograms have been useful for patient follow-up evaluation. Combined segmental mastectomy and breast reduction represents a valuable treatment option for the patient who presents with macromastia and carcinoma of the breast. The carcinoma ablative procedure is not compromised and the improved symmetry of the breast has resulted in an excellent cosmetic outcome in these patients.

Prior exposure to a running wheel and scheduled food attenuates polydipsia acquisition

Groups of rats were given different histories before exposure to daily, 2-h fixed-interval (FI) 1-min food-schedule sessions with water available. In a previous study, a group with a history of chronic exposure to FI 1-min sessions without water subsequently had a reduced rate of acquisition and final level of schedule-induced polydipsia compared to a control group lacking this history. In the present study, groups with histories of chronic exposure to FI 1-min sessions and a concurrent running wheel were even more attenuated in their subsequent acquisition of polydipsia. Substitution of 5% ethanol for session water in the final phase produced a convergence in group intakes, except for a group which continued to have access to the running wheel. The ethanol intake of this group was relatively suppressed.

Cervical cancer metastatic to the breast: a rare presentation of tumor dissemination

Metastatic disease presenting in the mammary gland from gynecologic malignancies is a rare occurrence. A case of metastatic adenosquamous carcinoma of the cervix presenting as an inflammatory breast lesion is reported. Metastases within the breast have distinct clinical, radiographic, and histologic features and should be suspected in a patient with a breast mass and a known extramammary primary. As with other distant metastases of cervical cancer, mammary gland involvement portends a poor prognosis.

The effect of cataract severity and morphology on the reliability of the Lens Opacities Classification System II (LOCS II)

Data collected from 3646 eyes in the Italian-American Natural History Study of Age-Related Cataract were used to investigate whether the reliability of the Lens Opacities Classification System II (LOCS II) by the severity of the opacity that is being graded or is influenced by the presence and severity of coexisting opacities. Reliability was assessed by comparing the slit-lamp gradings of two clinical examiners (346 eyes) and the gradings performed at the slit lamp with gradings of photographs (3646 eyes). The severity of cortical and nuclear opacities did not affect the reproducibility of slit-lamp gradings, but clinical grading of posterior subcapsular opacities became more reliable as the severity of the posterior subcapsular opacities increased. More advanced coexisting opacities decreased the agreement in the slit-lamp diagnosis of nuclear, but not cortical or posterior subcapsular, opacities. Comparisons of clinical and photographic gradings showed very good to excellent agreement for nuclear and cortical opacities, regardless of the severity of the specific opacity or the severity of the coexisting opacities. Agreement in diagnosing posterior subcapsular opacities was decreased in eyes with milder posterior subcapsular opacities and in eyes with more severe coexisting nuclear and/or cortical opacities. The effect of the severity of the opacity being graded and the severity of coexisting opacities on the reliability of the LOCS II must be considered in studies that use the system to classify and grade cataracts.

Effectiveness and tolerance of long-term malaria prophylaxis with mefloquine. Need for a better dosing regimen

To measure the effectiveness and tolerance of long-term malaria prophylaxis with mefloquine, the incidence of Plasmodium falciparum malaria and of adverse reactions was compared in Peace Corps volunteers in West Africa who took mefloquine every 2 weeks and in volunteers who took chloroquine phosphate weekly. Mefloquine was only 63% more effective than chloroquine; the monthly incidence of P falciparum infections was one case per 100 volunteers who took mefloquine and 2.7 cases per 100 volunteers who took chloroquine. Using daily proguanil (chloroguanide) hydrochloride in addition to chloroquine did not provide additional protection. All mefloquine prophylaxis failures occurred during the second week of the every-2-weeks dosing regimen in volunteers who had used mefloquine for more than 2 months. Blood concentrations of mefloquine were lower during the second week of the alternate-week regimen than during the first week, suggesting that blood levels are too low during the second week to suppress parasitemia. No serious adverse reactions were observed. The results indicate that a dosing regimen of 250 mg of mefloquine weekly should be considered for travelers to areas with chloroquine-resistant P falciparum malaria.

Effect of temperature on myosin phosphorylation in mouse skeletal muscle

The effect of muscle contraction on phosphorylatable myosin light chain (P-light chain) phosphate content and isometric twitch tension was examined at 25, 30, and 35 degrees C in intact mouse extensor digitorum longus muscle. Peak tetanic tension was unaffected by temperature, whereas peak unpotentiated isometric twitch tension was inversely proportional to muscle incubation temperature. The extent of phosphate incorporation into P-light chain elicited by a 20-s train of twitches (5/s) was inversely proportional to muscle incubation temperature, whereas the fractional increase in twitch tension (twitch potentiation) elicited by repetitive stimulation was directly proportional to muscle incubation temperature. After the twitch train, the rate of decline of potentiated twitch tension and of P-light chain dephosphorylation was directly proportional to muscle incubation temperature. The net result was that a significant and unique relationship between P-light chain phosphate content and contraction-induced tension potentiation existed at each temperature examined. The slope of the P-light chain phosphate vs. isometric twitch potentiation relationship varied directly as a function of muscle incubation temperature. The observations that the slope of this relationship increases and that unpotentiated twitch tension decreases when muscle incubation temperature is increased support the hypothesis that contraction-induced tension potentiation in intact mammalian skeletal muscle is the result of a sensitization of the contractile element to activation by Ca2+ that is brought about by P-light chain phosphorylation.

Trends in prescribing of antihypertensive drugs in Australia, 1977-1987

Prescribing of hypotensive agents, beta-blockers and diuretics was analysed using data from the Pharmaceutical Benefits Scheme, adjusted to reflect prescribing for hypertension, over 1977-1987. Prescribing of these three drug groups combined increased by approximately 50% over the period. Notable trends were decreased prescribing of bendrofluazide, chlorothiazide and methyldopa and increased prescribing of hydrochlorothiazide with amiloride, atenolol, metoprolol and prazosin, and, most recently, captopril and enalapril. The increase in prescribing of drugs for hypertension, combined with the choice of more expensive drugs, has resulted in a substantial increase in the drug costs associated with treating hypertension.

Generalization of therapeutic changes in agoraphobia: the role of perceived self-efficacy

Investigated the extent and mechanisms of therapeutic generalization across distinct areas of agoraphobic dysfunction. Twenty-seven severe agoraphobics were each given performance-based treatment for some phobic areas while leaving their other phobias untreated. Behavioral tests revealed that (a) the treated phobias improved significantly more than the untreated (transfer) phobias, (b) the transfer phobias improved significantly more than control phobias, and (c) the transfer benefits were highly variable within and between subjects. Analyses of possible cognitive mechanisms revealed that perceived self-efficacy accurately predicted treatment and transfer effects even when alternative factors such as previous behavior, anticipated anxiety, anticipated panic, perceived danger, and subjective anxiety were held constant. In contrast, these alternative factors lost most or all predictive value when self-efficacy was held constant. Agoraphobia thus appears to be neither a unitary entity nor a mere collection of independent phobias, but a complexly patterned problem governed largely by self-perceptions of coping efficacy.

The Bay Area Functional Performance Evaluation: development and standardization

The Bay Area Functional Performance Evaluation (BaFPE) was developed in 1977-1978 to meet the need for a reliable and valid instrument for assessing the general functional performance of patients treated in psychiatric occupational therapy. It consists of two subtests, the Task-Oriented Assessment and the Social Interaction Scale. These subtests evaluate two aspects of general functional performance--task-oriented and social behavior--that are important in assessing clients with emotional, cognitive, or behavioral deficits. This article traces the instrument's standardization over a 10-year period of development and includes a discussion of its theoretical premises, its content, and the revisions to date. Research on the reliability and validity of the BaFPE is summarized.