133 Factor’s Contrubuting for Non-Compliance Physiotherapy Sesions among Geriatric Patient at Physiotherapy Fall Intervention Program

Introduction

Current world is going through an increase in ageing population with one in eight people in the world are aged 60 or over. By 2025, 15 % of Malaysia population will be aged above 60 years old. Physiotherapy playing a major role in facilitates healthy ageing process. However, compliance to physiotherapy session is still low among geriatric population.

A defaulter was defined as a patient who presented for less than 6 visits during the whole period.

Method

A Retrospective study will calling patient after patient did not turn up the physiotherapy appointment and interview was done on appointment with the doctor together. This study was conducted at Geriatric Clinic, Hospital Kuala Lumpur. Physiotherapy session records were tracked to get there number of defaulters in Physiotherapy Geriatric clinic during 2017 & 2018.

Result

Reasons for defaulting the therapy session was gained via phone call interview and during Geriatrician appointment. Total of 223 samples were tracked and interviewed in this study. The result reveals 73% of the patients defaulted in 2017 and 51% in 2018 respectively. Lack of facilities comprises 22% of factors for non-compliance. Meanwhile other factors such as human resource and functional capabilities contribute 14% and 19% respectively for patient’s non-compliance.

Conclusion

As conclusion, clinic need to take steps such as call to remind their appointment and provide proper home education to increase patient’s compliance. Together with in poor compliance which was successfully brought down by taking into consideration patient factors. This may be the best compromise until which time where special parking lots, improved transportation services or adequate skilled facilities in the periphery are made available to the patients.

Quantitative validation of immunofluorescence and lectin staining using reduced CLARITY acrylamide formulations

The CLARITY technique enables three-dimensional visualization of fluorescent-labeled biomolecules in clarified intact brain samples, affording a unique view of molecular neuroanatomy and neurocircuitry. It is therefore, essential to find the ideal combination for clearing tissue and detecting the fluorescent-labeled signal. This method requires the formation of a formaldehyde-acrylamide fixative-generated hydrogel mesh through which cellular lipid is removed with sodium dodecyl sulfate. Several laboratories have used differential acrylamide and detergent concentrations to achieve better tissue clearing and antibody penetration, but the potential effects upon fluorescent signal retention is largely unknown. In an effort to optimize CLARITY processing procedures we performed quantitative parvalbumin immunofluorescence and lectin-based vasculature staining using either 4 or 8% sodium dodecyl sulfate detergent in combination with different acrylamide formulas in mouse brain slices. Using both confocal and CLARITY-optimized lightsheet microscope-acquired images, we demonstrate that 2% acrylamide monomer combined with 0.0125% bis-acrylamide and cleared with 4% sodium dodecyl sulfate generally provides the most optimal signal visualization amongst various hydrogel monomer concentrations, lipid removal times, and detergent concentrations.

Validation of screening tools to assess appetite among geriatric patients

Poor appetite is one of the main contributing factors of poor nutritional status among elderly individuals. Recognizing the importance of assessment of appetite, a cross sectional study was conducted to determine the validity of appetite screening tools namely, the Council on Nutrition Appetite questionnaire (CNAQ) and the simplified nutritional appetite questionnaire (SNAQ) against the appetite, hunger and sensory perception questionnaire (AHSPQ), measures of nutritional status and food intake among geriatric patients at the main general hospital in Malaysia. Nutritional status was assessed using the subjective global assessment (SGA) while food intake was measured using the dietary history questionnaire (DHQ). Anthropometric parameters included weight, height, body mass index (BMI), calf circumference (CC) and mid upper arm circumference (MUAC). A total of 145 subjects aged 60 to 86 years (68.3 ± 5.8 years) with 31.7% men and 68.3% women were recruited from outpatients (35 subjects) and inpatients (110 subjects) of Kuala Lumpur Hospital of Malaysia. As assessed by SGA, most subjects were classified as mild to moderately malnourished (50.4%), followed by normal (38.6%) and severely malnourished (11.0%). A total of 79.3% and 57.2% subjects were classified as having poor appetite according to CNAQ and SNAQ, respectively. CNAQ (80.9%) had a higher sensitivity than SNAQ (69.7%) when validated against nutritional status as assessed using SGA. However, the specificity of SNAQ (62.5%) was higher than CNAQ (23.2%). Positive predictive value for CNAQ and SNAQ were 62.6% and 74.7%, respectively. Cronbach's alpha for CNAQ and SNAQ were 0.546 and 0.578, respectively. History of weight loss over the past one year (Adjusted odds ratio 2.49) (p < 0.01) and thiamine intake less than the recommended nutrient intake (RNI) (Adjusted odds ratio 3.04) (p < 0.05) were risk factors for poor appetite among subjects. In conclusion, malnutrition and poor appetite were prevalent among the geriatric outpatients and inpatients. SNAQ was more reliable and valid as an appetite screening tool among this special group of population. There is a need to regularly include nutritional and appetite assessment for early intervention measures in order to prevent consequences of malnutrition.

Effect of brain-derived neurotrophic factor haploinsufficiency on stress-induced remodeling of hippocampal neurons

Chronic restraint stress (CRS) induces the remodeling (i.e., retraction and simplification) of the apical dendrites of hippocampal CA3 pyramidal neurons in rats, suggesting that intrahippocampal connectivity can be affected by a prolonged stressful challenge. Since the structural maintenance of neuronal dendritic arborizations and synaptic connectivity requires neurotrophic support, we investigated the potential role of brain derived neurotrophic factor (BDNF), a neurotrophin enriched in the hippocampus and released from neurons in an activity-dependent manner, as a mediator of the stress-induced dendritic remodeling. The analysis of Golgi-impregnated hippocampal sections revealed that wild type (WT) C57BL/6 male mice showed a similar CA3 apical dendritic remodeling in response to three weeks of CRS to that previously described for rats. Haploinsufficient BDNF mice (BDNF(±) ) did not show such remodeling, but, even without CRS, they presented shorter and simplified CA3 apical dendritic arbors, like those observed in stressed WT mice. Furthermore, unstressed BDNF(±) mice showed a significant decrease in total hippocampal volume. The dendritic arborization of CA1 pyramidal neurons was not affected by CRS or genotype. However, only in WT mice, CRS induced changes in the density of dendritic spine shape subtypes in both CA1 and CA3 apical dendrites. These results suggest a complex role of BDNF in maintaining the dendritic and spine morphology of hippocampal neurons and the associated volume of the hippocampal formation. The inability of CRS to modify the dendritic structure of CA3 pyramidal neurons in BDNF(±) mice suggests an indirect, perhaps permissive, role of BDNF in mediating hippocampal dendritic remodeling.

Brain-derived neurotrophic factor as a model system for examining gene by environment interactions across development

There has been a dramatic rise in gene x environment studies of human behavior over the past decade that have moved the field beyond simple nature versus nurture debates. These studies offer promise in accounting for more variability in behavioral and biological phenotypes than studies that focus on genetic or experiential factors alone. They also provide clues into mechanisms of modifying genetic risk or resilience in neurodevelopmental disorders. Yet, it is rare that these studies consider how these interactions change over the course of development. In this paper, we describe research that focuses on the impact of a polymorphism in a brain-derived neurotrophic factor (BDNF) gene, known to be involved in learning and development. Specifically we present findings that assess the effects of genotypic and environmental loadings on neuroanatomic and behavioral phenotypes across development. The findings illustrate the use of a genetic mouse model that mimics the human polymorphism, to constrain the interpretation of gene-environment interactions across development in humans.

Emotional incontinence--the other poststroke phenomenon

Emotional incontinence is a disorder of emotional control following brain damage. It refers to the heightened tendency to cry or less commonly laugh, out of proportion to the underlying mood. Recognition of this phenomenon is often lacking as it is confused with other related sequelae of brain damage such as depression. This is a case report of an elderly female exhibiting poststroke emotional incontinence.

Limit on the electron neutrino magnetic moment from the kuo-sheng reactor neutrino experiment

A search of neutrino magnetic moment was carried out at the Kuo-Sheng Nuclear Power Station at a distance of 28 m from the 2.9 GW reactor core. With a high purity germanium detector of mass 1.06 kg surrounded by scintillating NaI(Tl) and CsI(Tl) crystals as anti-Compton detectors, a detection threshold of 5 keV and a background level of 1 kg(-1) keV(-1) day(-1) at 12-60 keV were achieved. Based on 4712 and 1250 h of reactor ON and OFF data, respectively, the limit on the neutrino magnetic moment of mu(nu;(e))<1.3x10(-10)mu(B) at 90% confidence level was derived. An indirect bound of the nu;(e) radiative lifetime of m(3)(nu)tau(nu)>2.8x10(18) eV(3) s can be inferred.

HIF-1alpha binding to VHL is regulated by stimulus-sensitive proline hydroxylation

Hypoxia-inducible factor-1alpha (HIF-1alpha) is a global transcriptional regulator of the hypoxic response. Under normoxic conditions, HIF-1alpha is recognized by the von Hippel-Lindau tumor-suppressor protein (VHL), a component of an E3 ubiquitin ligase complex. This interaction thereby promotes the rapid degradation of HIF-1alpha. Under hypoxic conditions, HIF-1alpha is stabilized. We have previously shown that VHL binds in a hypoxia-sensitive manner to a 27-aa segment of HIF-1alpha, and that this regulation depends on a posttranslational modification of HIF-1alpha. Through a combination of in vivo coimmunoprecipitation assays using VHL and a panel of point mutants of HIF-1alpha in this region, as well as MS and in vitro binding assays, we now provide evidence that this modification, which occurs under normoxic conditions, is hydroxylation of Pro-564 of HIF-1alpha. The data furthermore show that this proline hydroxylation is the primary regulator of VHL binding.

IκB Kinase Is Critical for TNF-α-Induced VCAM1 Gene Expression in Renal Tubular Epithelial Cells

The expression of VCAM1 is up-regulated in renal proximal tubular epithelial cells (TEC) in a variety of inflammatory renal diseases, a prominent example of which is acute renal allograft rejection. VCAM1 may play an important role in these diseases because it binds to the integrins very late Ag-4 and alpha(4)beta(7) on lymphocytes and monocytes, thereby providing a potential mechanism to recruit these leukocytes to sites of inflammation. The molecular mechanisms underlying VCAM1 regulation in renal TEC are essentially unknown. We now report that VCAM1 mRNA is dramatically up-regulated in C1, a cell line derived from renal TEC, on exposure to TNF-alpha. Two NF-kappaB binding sites in the VCAM1 promoter are critical for the TNF-alpha-induced VCAM1 transcriptional up-regulation, and both sites bind to p65-p50 NF-kappaB complexes. TNF-alpha induces activation of inhibitor of NF-kappaB (IkappaB) kinase-beta (IKK-beta), a protein kinase that phosphorylates the NF-kappaB inhibitor IkappaB, and thereby targets the latter for degradation via the ubiquitin-proteasome pathway. Moreover, dominant negative versions of IKK inhibit TNF-alpha activation of a VCAM1 promoter reporter. We conclude that the IKK/NF-kappaB pathway is critical in the TNF-alpha-induced up-regulation of VCAM1 mRNA in renal TEC.

The uniqueness of being a neurotrophin receptor

Neurotrophins rely on Trk tyrosine kinase and p75 receptors for signal transduction. Recently, other roles for these receptors have been identified. Many questions have been raised about the mechanism by which these receptors mediate diverse cellular functions. Studies indicate a great deal of neurotrophin signaling specificity may stem from ligand-receptor selectivity and intracellular protein recruitment.

Dynamic, site-specific interaction of hypoxia-inducible factor-1alpha with the von Hippel-Lindau tumor suppressor protein

Hypoxia-inducible factor (HIF)-1alpha is a transcription factor that plays a critical role in regulating genes involved in erythropoiesis and angiogenesis. Recent evidence indicates that the von Hippel-Lindau tumor suppressor protein (VHL) is part of a ubiquitin ligase complex that promotes the degradation of HIF-1alpha under normoxic conditions. Under hypoxic conditions, HIF-1alpha is markedly stabilized. A critical issue in understanding the hypoxic response is the identification of hypoxia-regulated steps. We show here that hypoxia and cobalt treatment modulate the capacity of a HIF-1alpha fragment comprising residues 531-652 to coimmunoprecipitate with VHL. Hypoxia and cobalt both significantly diminish the interaction, and furthermore, normoxia treatment after hypoxia rapidly normalizes it. This HIF-1alpha fragment confers hypoxia and cobalt inducibility on a heterologous protein. Significantly, contained within this fragment is a short 27-residue sequence that behaves identically in all respects noted above. Finally, evidence is provided to show that cobalt and hypoxia both induce a posttranslational modification (or loss of one) in HIF-1alpha that affects its binding to VHL. We propose that dynamic, site-specific interaction of HIF-1alpha with VHL provides one mechanism by which HIF-1alpha can be regulated.

Activation of Trk neurotrophin receptors in the absence of neurotrophins

Neurotrophins regulate neuronal cell survival and synaptic plasticity through activation of Trk receptor tyrosine kinases. Binding of neurotrophins to Trk receptors results in receptor autophosphorylation and downstream phosphorylation cascades. Here, we describe an approach to use small molecule agonists to transactivate Trk neurotrophin receptors. Activation of TrkA receptors in PC12 cells and TrkB in hippocampal neurons was observed after treatment with adenosine, a neuromodulator that acts through G protein-coupled receptors. These effects were reproduced by using the adenosine agonist CGS 21680 and were counteracted with the antagonist ZM 241385, indicating that this transactivation event by adenosine involves adenosine 2A receptors. The increase in Trk activity could be inhibited by the use of the Src family-specific inhibitor, PP1, or K252a, an inhibitor of Trk receptors. In contrast to other G protein-coupled receptor transactivation events, adenosine used Trk receptor signaling with a longer time course. Moreover, adenosine activated phosphatidylinositol 3-kinase/Akt through a Trk-dependent mechanism that resulted in increased cell survival after nerve growth factor or brain-derived neurotrophic factor withdrawal. Therefore, adenosine acting through the A(2A) receptors exerts a trophic effect through the engagement of Trk receptors. These results provide an explanation for neuroprotective actions of adenosine through a unique signaling mechanism and raise the possibility that small molecules may be used to elicit neurotrophic effects for the treatment of neurodegenerative diseases.

Association of Trk neurotrophin receptors with components of the cytoplasmic dynein motor

Nerve growth factor (NGF) initiates its trophic effects by long-range signaling through binding, internalization, and transport of a ligand-receptor complex from the axon terminal to the cell body. However, the mechanism by which retrograde transport of NGF takes place has not been elucidated. Here we describe an interaction between the Trk receptor tyrosine kinase and a 14 kDa light chain of cytoplasmic dynein. After transfection in human embryonic kidney 293 cells, this 14 kDa dynein light chain was found to bind to TrkA, TrkB, and TrkC receptors. Mapping experiments indicated that the 14 kDa dynein light chain binds to the distal region of the TrkA juxtamembrane domain. Coimmunoprecipitation experiments in vivo indicate that Trk receptors are in a complex with the 14 kDa light chain and 74 kDa intermediate chain of dynein. Confirming the physiological relevance of this association, a marked accumulation of Trk with the 14 kDa and the 74 kDa dynein components was observed after ligation of the sciatic nerve. The association of Trk receptors with components of cytoplasmic dynein suggests that transport of neurotrophins during vesicular trafficking may occur through a direct interaction of the Trk receptor with the dynein motor machinery.

Analysis of nitrated polynuclear aromatic hydrocarbons

A derivatization-gas chromatography/electron capture detector (GC/ECD) method has been developed for the measurement of trace nitrated polynuclear aromatic hydrocarbons (NPAHs) in air. The method involves first the derivatization of parent nitro-PAHs to their corresponding fluorinated derivatives, followed by GC/ECD analysis. The sensitivity of the method is an order of magnitude higher than those of direct GC/ECD analysis of NPAHs themselves. The method is simple and robust and thus ideally suited for the routine monitoring of NPAHs in air samples. The sensitivity and reproducibility of GC/negative ion chemical ionization MS (NICIMS) for the measurement of NPAHs after derivatization has been evaluated. The method has sensitivity comparable to GC/ECD, but is less reproducible in quantification. The method is therefore suitable for method validation and NPAHs peak confirmation rather than routine operations.

Human granulocytic ehrlichiosis presenting as facial diplegia in a 42-year-old woman

Neurologic manifestations of human ehrlichiosis are unusual and have been described almost exclusively in human monocytic ehrlichiosis associated with Ehrlichia chaffeensis. We report here a case of a previously healthy 42-year-old woman who developed bilateral facial nerve palsies in association with infection by the agent of human granulocytic ehrlichiosis (aoHGE). The diagnosis was made by specific polymerase chain reaction amplification of aoHGE sequences from samples of the patient's blood and cerebrospinal fluid (CSF), as well as propagation of aoHGE in culture of HL60 cells inoculated with the patient's CSF. To our knowledge, this is the first report directly demonstrating the presence of aoHGE in CSF, and it underscores the importance of considering HGE in patients presenting with a nonspecific febrile illness and unexplained neurologic manifestations. HGE should also be considered in the differential diagnosis of bilateral facial palsy-a rare occurrence.

IP-10 is critical for effector T cell trafficking and host survival in Toxoplasma gondii infection

The generation of an adaptive immune response against intracellular pathogens requires the recruitment of effector T cells to sites of infection. Here we show that the chemokine IP-10, a specific chemoattractant for activated T cells, controls this process in mice naturally infected with Toxoplasma gondii. Neutralization of IP-10 in infected mice inhibited the massive influx of T cells into tissues and impaired antigen-specific T cell effector functions. This resulted in >1000-fold increase in tissue parasite burden and a marked increase in mortality compared to control antibody-treated mice. These observations suggest that IP-10 may play a broader role in the localization and function of effector T cells at sites of Th1 inflammation.

Gender-specific effects of drugs on hearing levels of older persons

As part of a study of human presbyacusis, a questionnaire on medicinal drug usage was given to 357 subjects (184 females, 173 males). Previous results from 211 subjects showed gender effects, that is, for males, none of the drugs had any measurable effects on hearing, whereas women taking calcium channel blockers (CCBs) had hearing levels 12 dB better than women not taking them; women taking beta adrenergic medication had hearing levels 20 dB poorer, and women taking antihistamine/cold preparations had hearing levels 9 dB poorer. Results from the original 211 subjects were confirmed when the sample size was increased from 211 to 357 subjects only for the beta adrenergic medications. Results for antihistamine/cold preparation medications showed small effects only for female subjects. Data from 13 additional female subjects who used CCBs showed hearing levels 10-14 dB poorer than predicted from the original data. Male data were consistent in both samples. The inconsistency for females could reflect sampling error. A more likely possibility is that since the original 10 subjects using CCBs had a mean age of 72 yr and the second sample of 13 had a mean age of 79.5 yr, poorer hearing levels might be anticipated because of the difference in chronological age and possibly duration of drug usage.

[Estimation of the octanol-water partition coefficients of PAHs by solid-phase microextraction]

Eleven PAHs were analyzed by solid-phase microextraction-gas chromatography/ion trap detector and their partition coefficients were obtained at equilibrium. When the polymer coating of the fiber may be viewed as one kind of organic solvent, the linear free energy relationship between the polydimethylsiloxane-water partition coefficient (Ksw) and octanol-water partition coefficient (Kow) was established by solid-phase microextraction, which was log Ksw = 0.9318 log Kow-0.2056 with good correlation coefficient 0.9504. The linear equation may be used to estimate the octanol-water partition coefficient of other PAHs and similar H acceptors compounds. Being compared with Leo's method which was based on the additive-constitutive nature of the partition coefficient, the solid-phase microextraction method may distinguish efficiently Kow of the isomer.

Mitogen-activated protein kinase/ERK kinase kinases 2 and 3 activate nuclear factor-kappaB through IkappaB kinase-alpha and IkappaB kinase-beta

Recent evidence indicates that nuclear factor-kappaB (NF-kappaB), a transcription factor critically important for immune and inflammatory responses, is activated by a protein kinase cascade. The essential features of this cascade are that a mitogen-activated protein kinase kinase kinase (MAP3K) activates an IkappaB kinase (IKK) that site-specifically phosphorylates IkappaB. The IkappaB protein, which ordinarily sequesters NF-kappaB in the cytoplasm, is subsequently degraded by the ubiquitin-proteasome pathway, thereby allowing the nuclear translocation of NF-kappaB. Thus far, only two MAP3Ks, NIK and MEKK1, have been identified that can activate this pathway. We now show that MEKK2 and MEKK3 can in vivo activate IKK-alpha and IKK-beta, induce site-specific IkappaBalpha phosphorylation, and, relatively modestly, activate an NF-kappaB reporter gene. In addition, dominant negative versions of either IKK-alpha or IKK-beta abolish NF-kappaB activation induced by MEKK2 or MEKK3, thereby providing evidence that these IKKs mediate the NF-kappaB-inducing activities of these MEKKs. In contrast, other MAP3Ks, including MEKK4, ASK1, and MLK3, fail to show evidence of activation of the NF-kappaB pathway. We conclude that a distinct subset of MAP3Ks can activate NF-kappaB.

Simplex Optimization of PCA-Based Infrared Expert Systems

This paper describes an improved principal component analysis-based infrared expert system. The simplex algorithm is used to optimize the feature weight spectrum, thereby increasing the separation of different classes of compounds. First, the classification of a two-class system is significantly improved. Analysis indicates that compounds having more than three classes can also be separated in a single step using the same approach. This can simplify the structural elucidation tree in an expert system. Also reported here are factors influencing optimization of the feature weight spectra, including the initial data matrix and the step size of the optimization.

A comparison of root surface temperatures using different obturation heat sources

This study compared root surface temperatures produced during warm vertical obturation using the System B Heat Source (SB), the Touch 'n Heat device (TH), and a flame-heated carrier (FH). The root canals of 30 maxillary incisor, premolar, and mandibular incisor teeth were prepared; divided into three groups; and obturated using each heat source. A thermocouple placed 2 mm below the cementoenamel junction transferred the temperature rise on the external root surface to a digital thermometer. SB surface temperature rise was < 10 degrees C for all experimental teeth. TH temperature rise in maxillary incisors and premolars was < 10 degrees C; however, > 10 degrees C was observed for mandibular incisors. FH produced a > 10 degrees C surface temperature rise in all experimental teeth. The critical level of root surface heat required to produce irreversible bone damage is believed to be > 10 degrees C. The findings of this study suggest that warm vertical condensation with the SB should not damage supporting periradicular tissues. However, caution should be used with TH and FH on mandibular incisors.

MEKK1 activates both IkappaB kinase alpha and IkappaB kinase beta

A critical step in the signal-induced activation of the transcription factor NF-kappaB is the site-specific phosphorylation of its inhibitor, IkappaB, that targets the latter for degradation by the ubiquitin-proteasome pathway. We have previously shown that mitogen-activated protein kinase/ERK kinase kinase 1 (MEKK1) can induce both this site-specific phosphorylation of IkappaB alpha at Ser-32 and Ser-36 in vivo and the activity of a high molecular weight IkappaB kinase complex in vitro. Subsequently, others have identified two proteins, IkappaB kinase alpha (IKK-alpha) and IkappaB kinase beta (IKK-beta), that are present in a tumor necrosis factor alpha-inducible, high molecular weight IkappaB kinase complex. These kinases are believed to directly phosphorylate IkappaB based on the examination of the kinase activities of IKK immunoprecipitates, but more rigorous proof of this has yet to be demonstrated. We show herein that recombinant IKK-alpha and IKK-beta can, in fact, directly phosphorylate IkappaB alpha at Ser-32 and Ser-36, as well as homologous residues in IkappaB beta in vitro, and thus are bona fide IkappaB kinases. We also show that MEKK1 can induce the activation of both IKK-alpha and IKK-beta in vivo. Finally, we show that IKK-alpha is present in the MEKK1-inducible, high molecular weight IkappaB kinase complex and treatment of this complex with MEKK1 induces phosphorylation of IKK-alpha in vitro. We conclude that IKK-alpha and IKK-beta can mediate the NF-kappaB-inducing activity of MEKK1.

Reconstruction of intrinsic hand deformities

Intrinsic muscle contractures are a frequently overlooked cause of hand dysfunction. Tightness of these muscles may occur despite appropriate management. This article addresses the evaluation and treatment of these contractures.

[Measurements of Ar(I) excitation temperatures and electron number densities in an ICP with and without the presence of Freon 12--the development of ICP technology for hazardous waste management]

For the management of refractory hazardous wastes, an innovative technology emerging recently is the application of ultra high temperature plasma. The preliminary study on destruction of Freon 12 by ICP (1-2kW) under a joint program between Xiamen Univ. and Hong Kong Baptist Univ. showed that the ICP technology indeed holds a great potential for hazardous wastes management. The destruction efficiency is more than 99.9999%. With and without the presence of Freon 12, Ar(I) excitation temperatures were measured by Boltzmann plot method and electron number densities the by H (beta) line broadening method. It was found that above the load coil, the excitation temperatures and electron number densities decrease with increasing the amount of Freon 12 presented in the central channel of the ICP, but inside the load coil region, the excitation temperatures are affected little by Freon 12. The conclusion of thermal pinch could be expected from this phenomenon.

Analysis of blood chemistry and hearing levels in a sample of older persons

OBJECTIVE

As part of an ongoing study of presbyacusis, the relationship between blood chemistry levels and hearing levels was investigated. Previous reports often used small sets of blood chemistry measures, and results were inconclusive. This experiment examined hearing levels and 27 measures of blood chemistry using various univariate and multivariate statistical procedures.

DESIGN

Blood from 89 female and 128 male human subjects was collected. Subjects' ages ranged from 60 to 82 yr, and hearing levels ranged from normal to moderate/severe. Subjects with a history of middle ear disease were excluded. Electrolyte panel (Na, K, Cl, CO2, Ca, urea nitrogen, glucose, creatinine, and Mg), hematology panel (WBC, RBC, Hgb, hematocrit, platelet, etc.), serum lipids (total cholesterol, low-density lipoprotein [LDL], and high-density lipoprotein [HDL]), immunoglobulins (IgG, IgA, IgM, and IgE), and thyroxine were analyzed using univariate and multivariate statistical procedures.

RESULTS

Blood chemistry levels of most subjects were within normal ranges as defined by our laboratory. Correlation between blood chemistry measures and pure-tone averages (PTAs) ranged from minimal to low. Results of factor analysis, discriminant analysis, and canonical analysis showed that combining blood chemistry measures from the same panel still could not predict PTA effectively. One exception to this was a gender-specific effect of cholesterol. Hearing levels of women with high LDL/HDL ratios were 5 dB better than those of women with low LDL/HDL ratios. The comparable difference in men was only 1 dB.

CONCLUSION

Results suggest that blood chemistry measures that are primarily within the normal range have very little value in predicting pure-tone thresholds in older subjects.

[Influences of Freon-12 (CF2CCl2) on the electron number densities in an inductively coupled plasma (ICP) measured with Halpha line--the applications of ICP in the disposal of hazardous waste]

The inductively coupled plasma was applied to decompose Freon 12 (CF2CCl2). The efficiency of the decomposition was indirectly evaluated by comparing the electron number densities in the central channel of the ICP with the addition of different amounts of Freon-12. Halpha line (656.3nm) was used to measure the electron number density due to Hbeta line (486.1nm) is seriously interfered with the addition of Freon-12 under the selected operating conditions. The "thermal pinch" effect was found with the addition of Freon-12, which is beneficial to the complete decomposition of the compound.

Gender-specific effects of medicinal drugs on hearing levels of older persons

As part of a large-scale study of presbyacusis, responses to a medicinal drug questionnaire from 85 female and 126 male human subjects were analyzed. Medicinal drugs were divided into 35 categories based on their pharmacologic effects. Subjects' ages ranged from 60 to 82 years. At least 10% of subjects reported taking drugs in 14 of 35 categories. Results were significantly different between female and male subjects. In men, none of the 14 categories showed a statistically significant relation to the pure-tone average (PTA) of 500, 1000, 2000, and 4000 Hz. In women, 3 of the 14 categories showed a statistically significant relation to the PTA. First, the average PTA of female subjects taking beta-adrenergic medication was 20 dB higher (poorer) than those not taking beta-adrenergic medication. Second, women taking antihistamine/cold preparations had an average PTA 9 dB higher (poorer) than those not taking antihistamine/cold preparations. Third, the average PTA of women taking calcium-channel blockers (CCBs) was 12 dB lower (better) than those not taking CCBs. In men, however, these drugs produced effects on the PTA of less than 3 dB. Differences between women and men were not explainable by differences in age or hearing level.

Synaptic vesicle glutamate uptake in epileptic (EL) mice

The ATP-dependent glutamate uptake system of synaptic vesicles was investigated in epileptic (EL) mice to determine whether glutamate uptake activity correlates with seizure susceptibility or development. Given the focal seizure onset, glutamate uptake activity was measured in four separate brain regions: cerebrum (minus hippocampus), hippocampus, cerebellum, and brain stem. The EL values were compared to those of age-matched controls; DDY and ABP/LeJ (ABP) mice. The glutamate uptake specific activity for EL cerebrum was significantly higher than that for the control mice (approx. 400 days old), but was not elevated prior to seizure onset (46 days old). No difference in glutamate uptake was observed between the strains in the other brain regions. We conclude that increased synaptic vesicle glutamate uptake is brain-region specific (cerebrum) and is associated with the development or maintenance, rather than the initial cause, of seizures in the EL model of epilepsy.

A protein factor that inhibits ATP-dependent glutamate and gamma-aminobutyric acid accumulation into synaptic vesicles: purification and initial characterization

Glutamate, the major excitatory neurotransmitter in the mammalian central nervous system, is transported into and stored in synaptic vesicles. We have purified to apparent homogeneity a protein from brain cytosol that inhibits glutamate and gamma-aminobutyric acid uptake into synaptic vesicles and have termed this protein "inhibitory protein factor" (IPF). IPF refers to three distinct proteins with relative molecular weights of 138,000 (IPF alpha), 135,000 (IPF beta), and 132,000 (IPF gamma), respectively. Gel filtration and sedimentation data suggest that all three proteins share an elongated structure, identical Stokes radius (60 A), and identical sedimentation coefficient (4.3 S). Using these values and a partial specific volume of 0.716 ml/g, we determined the native molecular weight for IPF alpha to be 103,000. Partial sequence analysis shows that IPF alpha is derived from alpha fodrin, a protein implicated in several diverse cellular activities. IPF alpha inhibits ATP-dependent glutamate uptake into purified synaptic vesicles with an IC50 of approximately 26 nM, while showing no ability to inhibit ATP-independent uptake at concentrations up to 100 nM. Moreover, IPF alpha inhibited neither norepinephrine uptake into chromaffin vesicles nor Na+-dependent glutamate uptake into synaptosomes. However, IPF alpha inhibited uptake of gamma-aminobutyric acid into synaptic vesicles derived from spinal cord, suggesting that inhibition may not be limited to glutamatergic systems. We propose that IPF could be a novel component of a presynaptic regulatory system. Such a system might modulate neurotransmitter accumulation into synaptic vesicles and thus regulate the overall efficacy of neurotransmission.

Age-related and gender-related changes in monaural speech recognition

Previous studies of older listeners suggest age-related declines in speech recognition. However, the interpretation of these results is not straightforward because auditory thresholds, which account for the largest proportion of the variance in speech-recognition scores, also vary considerably with age. Here, effects of age, gender, and auditory thresholds on several measures of speech recognition were assessed for a large sample of individuals enrolled in a longitudinal study of age-related hearing loss. Participants ranged in age from 55-84 years. They were evaluated with a battery of conventional audiometric measures and speech-recognition materials, including NU-6 monosyllabic words, Synthetic Sentence Identification sentences, and high-context and low-context sentences from the Speech Perception in Noise test. Two analyses were conducted to assure that changes in speech-recognition scores with age were examined independently of age-related changes in auditory thresholds. In the first analysis, no significant differences in speech recognition were observed for individuals in three age groups (55-64, 65-74, 75-84 years) who were selected so that average puretone thresholds for the groups were within 5 dB. In the second analysis, using partial correlations to adjust both score and age for their association with average thresholds, significant declines with age were observed for males in maximum word recognition, maximum synthetic sentence identification, and keyword recognition in high-context sentences. For females, no significant changes in speech recognition with age were observed for any test.

Extended high-frequency thresholds in older adults

Most measures of auditory sensitivity at extended high frequencies (frequencies greater than 8 kHz) have been obtained from listeners with normal hearing less than 40 years of age. The purpose of this study was (a) to measure thresholds at frequencies above 8 kHz in older listeners who, as a group, have elevated thresholds at lower frequencies, and (b) to assess test-retest reliability, age and gender effects, and the influence of thresholds below 8 kHz. Extended high-frequency (EHF) thresholds were measured for 162 older listeners (60-79 years) using a commercially available high-frequency audiometer, with a frequency range of 8 to 18 kHz and an intensity range of 0 to 110 dB SPL. Thresholds were measured once at the beginning of a 1- to 2-hour test session and then remeasured at the end of the test session. EHF thresholds of older listeners with normal hearing at conventional audiometric frequencies were substantially higher than the thresholds reported for younger listeners, with normal hearing by Dreschler and van der Hulst (1987). EHF thresholds of older listeners with hearing loss at conventional audiometric frequencies were further elevated as compared to older listeners with normal hearing. Differences in EHF thresholds between females and males were either not present or were reduced when gender differences in conventional audiometric thresholds were taken into account. No significant differences were seen in thresholds at 8 kHz and higher between the 60- to 69-and 70- to 79-year-old age groups. Results also indicated that thresholds above 8 kHz can be measured in older listeners within a clinically acceptable +/- 10 dB test-retest range.

Activation of the IkappaB alpha kinase complex by MEKK1, a kinase of the JNK pathway

Both NF-kappaB and c-Jun are activated by cytokines such as TNF-alpha and by stresses such as UV irradiation. A key step in the activation of NF-kappaB is the phosphorylation of its inhibitor, IkappaB alpha, by a ubiquitination-inducible multiprotein kinase complex (IkappaB alpha kinase). A central kinase in the c-Jun activation pathway is mitogen-activated protein kinase/ERK kinase kinase-1 (MEKK1). Here, we show that MEKK1 induces the site-specific phosphorylation of IkappaB alpha in vivo and, most strikingly, can directly activate the IkappaB alpha kinase complex in vitro. Thus, MEKK1 is a critical component of both the c-Jun and NF-kappaB stress response pathways. Since the IkappaB alpha kinase complex can be independently activated by ubiquitination or MEKK1-dependent phosphorylation, it may be an integrator of multiple signal transduction pathways leading to the activation of NF-kappaB.

Topical tetracaine attenuates the pain of infiltration of buffered lidocaine

OBJECTIVE

To determine whether topical tetracaine attenuates the pain of buffered lidocaine infiltration.

METHODS

A prospective, randomized, double-blind trial was conducted involving adults with lacerations being repaired following local anesthesia. Two 0.5-mL injections of buffered lidocaine were given in a standardized manner. Injection 1 was given prior to application of topical study solution. Injection 2 was given on the opposite side of the laceration after topical application of a study solution that was 4 mL of either tetracaine or normal saline. Pain of each infiltration was measured using a visual analog pain scale. Pain score differences (injection 1 - injection 2) were compared for the 2 study solutions using a Wilcoxon 2-sample signed-rank test.

RESULTS

Of 57 subjects studied, 29 received tetracaine and 28 received saline. The groups were similar in age, gender, wound length, wound location, and initial pain score. Pain scores decreased significantly in the tetracaine group as compared with the saline group. The median pain score difference for tetracaine was 12.0 mm, with an interquartile range (IQR) of 2 to 43 mm, as compared with 2 mm, with an IQR of - 17 to 21 mm for saline (p = 0.048).

CONCLUSION

Topical tetracaine attenuates the pain of infiltration of buffered lidocaine.

Confidence limits for maximum word-recognition scores

Clinical judgments are often made regarding whether maximum word-recognition scores (PBmax) are appropriate in relation to degree of sensorineural hearing loss. In order to determine if word recognition is significantly poorer than expected, it is necessary to consider the lower boundary of PBmax associated with a particular degree of hearing loss for speech materials commonly used to measure word recognition. The purpose of this experiment was to define a confidence limit for PBmax from Northwestern University Test #6 (NU-6) word-recognition scores obtained from a large group of young and aged subjects with confirmed cochlear hearing loss. Word-recognition scores at several speech levels were obtained from 407 ears with a wide range of pure-tone averages. Because the characteristics of the distribution of maximum scores are not known, a procedure was developed using computer simulations to approximate the distribution of word-recognition scores corresponding to PBmax and determine the 95% confidence limit (CL). Results of the simulation were confirmed by comparing means and standard deviations of PBmax derived from experimental and simulation data. Percentages of young and aged subjects with scores outside the 95% CL are equal to their proportions in the entire subject sample. If PBmax determined from a score-level psychometric function is poorer than the 95% CL, PBmax may be considered "disproportionately" poor in relation to the degree of hearing loss. One score measured at a single arbitrary suprathreshold level that is poorer than the 95% CL suggests that the score may underestimate PBmax and that word recognition should be measured at additional levels to obtain a more reasonable estimate of the listener's maximum word-recognition score.

Insertional mutagenesis identifies a member of the Wnt gene family as a candidate oncogene in the mammary epithelium of int-2/Fgf-3 transgenic mice

Transgenic mice harboring the int-2/Fgf-3 protooncogene under transcriptional control of the mouse mammary tumor virus (MMTV) promoter/enhancer exhibit a dramatic, benign hyperplasia of the mammary gland. In one int-2 transgenic line (TG.NX), this growth disturbance is evoked by pregnancy and regresses after parturition. Regression of hyperplastic mammary epithelium is less complete after successive pregnancies, and, within 10 months, most TG.NX mice stochastically develop mammary carcinomas that are transplantable in virgin, syngeneic mice. To identify genes that cooperate with int-2 in cell transformation, we infected TG.NX transgenic mice with MMTV. In a cohort of 14 animals, most mammary tumors represented clonal or oligoclonal outgrowths harboring one to five proviral MMTV integrants. Eight of 35 (23%) MMTV+ tumors exhibited proviral insertion at the Wnt-1 locus. No provirus was detected at the int-2, int-3, or Wnt-3 loci. By Southern analysis, two tumors had proviral insertions at the same genomic location, which was mapped to chromosome 15. Cloning of this int locus identified an additional member of the Wnt gene family. The predicted 389-amino acid protein is most closely related to zebrafish Wnt-10a (58% amino acid identity over 362 residues) and, based on homology analysis, was designated Wnt-10b. This newly discovered Wnt family member was expressed in the embryo and mammary gland of virgin but not pregnant mice and represents a candidate collaborating oncogene of int-2/Fgf-3 in the mammary epithelium.

Calculations of antibody-antigen interactions: microscopic and semi-microscopic evaluation of the free energies of binding of phosphorylcholine analogs to McPC603

The study of antibody-antigen interactions should greatly benefit from the development of quantitative models for the evaluation of binding free energies in proteins. The present work addresses this challenge by considering the test case of the binding free energies of phosphorylcholine analogs to the murine myeloma protein McPC603. This includes the evaluation of the differential binding energy as well as the absolute binding energies and their corresponding electrostatic contributions. Four different approaches are examined: the Protein Dipoles Langevin Dipoles (PDLD) method, the semi-microscopic PDLD (PDLD/S) method, a free energy perturbation (FEP) method based on an adiabatic charging procedure and a linear response approximation that accelerates the FEP calculation. The PDLD electrostatic calculations are augmented by estimates of the relevant hydrophobic and steric contributions. The determination of the hydrophobic energy involves an approach which considers the modification of the effective surface area of the solute by local field effects. The steric contributions are analyzed in terms of the corresponding reorganization energies. This treatment, which considers the protein as a harmonic system, views the steric forces as the restoring forces for the electrostatic interactions. The FEP method is found to give unreliable results with regular cut-off radii and starts to give quantitative results only in very expensive treatment with very large cut-off radii. The PDLD and PDLD/S methods are much faster than the FEP approach and give reasonable results for both the relative and absolute binding energies. The speed and simplicity of the PDLD/S method make it an effective strategy for interactive docking studies and indeed such an option is incorporated in the program MOLARIS. A component analysis of the different energy contributions of the FEP treatment and a similar PDLD analysis indicate that electrostatic effects provide the largest contribution to the differential binding energy, while the hydrophobic and steric contributions are much smaller. This finding lends further support to the idea that electrostatic interactions play a major role in determining the antigen specificity of McPC603.

Transgenes expressing the Wnt-1 and int-2 proto-oncogenes cooperate during mammary carcinogenesis in doubly transgenic mice

The Wnt-1 and int-2 proto-oncogenes are transcriptionally activated by mouse mammary tumor virus insertion mutations in virus-induced tumors and encode secretory glycoproteins. To determine whether these two genes can cooperate during carcinogenesis, we have crossed two previously characterized lines of transgenic mice to obtain bitransgenic animals carrying both Wnt-1 and int-2 transgenes under the control of the mouse mammary tumor virus long terminal repeat. Mammary carcinomas appear earlier and with higher frequency in the bitransgenic animals, especially the males, than in either parental line. Nearly all bitransgenic males develop mammary neoplasms within 8 months of birth, whereas only 15% of Wnt-1 transgenic males and none of the int-2 transgenic males have tumors. In virgin bitransgenic females, tumors occur approximately 2 months earlier than in their Wnt-1 transgenic siblings; int-2 transgenic females rarely exhibit tumors. Preneoplastic glands from the bitransgenic animals of either sex demonstrate pronounced epithelial hyperplasia similar to that seen in Wnt-1 transgenic virgin females and males, and both transgenes are expressed in the hyperplastic glands and mammary tumors. RNA from the int-2 transgene is more abundant in mammary glands from bitransgenic animals than from int-2 transgenic animals; the increase is associated with high levels of RNA specific for keratin genes 14 and 18, suggesting that Wnt-1-induced epithelial hyperplasia is responsible for the observed increase in expression of the int-2 transgene.