Co-design of an intervention to optimize mammographic screening participation in women with obesity and/or physical disabilities

BACKGROUND

Mammographic breast screening/rescreening rates are suboptimal for women with obesity and/or physical disabilities. This study describes development of an intervention framework targeting obesity- and disability-related barriers to improve participation.

METHODS

Mixed methods combined a systematic review with first-person perspectives to optimise screening engagement among women with obesity and/or physical disabilities. Phase 1 (systematic review) was conducted following the PRISMA framework. Phase 2 involved in-depth interviews with n = 8 women with lived experience of obesity and/or physical disabilities. An inductive coding approach was applied to the data which was then combined with Phase 1 results to develop the intervention framework.

RESULTS

Six studies were included in the systematic review. Tailored education based on individual risk increased willingness to undergo mammographic screening. Recommendations to improve the screening experience included partnerships with consumers, targeted messaging, and enhanced professional development for breast screening staff. Participants also identified strategies to improve the uptake of screening and the experience itself.

CONCLUSION

Development and evaluation of interventions informed by frameworks like the one developed in this study are needed to improve engagement in screening to promote regular participation among women with physical disabilities and/or obesity.

IMPLICATIONS FOR PRACTICE

Successful implementation of practice interventions co-designed by women with obesity and/or physical disabilities are likely to improve their breast screening participation. Enhanced training of radiographers aimed at upskilling in empathetic communication around required manoeuvring and potentially longer screening times for clients with obesity and/or physical disabilities may encourage more positive client practitioner interactions. Client information aimed at women with obesity should include information on how to prepare for the appointment and explain there may be equipment limitations compromising imaging which may not be completed at an initial appointment.

Effect of woodchip bedding during wet conditions on feedlot cattle productivity, behaviour and relative adrenal gland weight

Problems associated with muddy pens have been identified as some of the most serious animal welfare issues related to outdoor feedlot beef production, but there is relatively little work examining the use of woodchip bedding for lot-fed beef cattle under conditions of cold, wet, but non-freezing winters on soil under-bases. This study examined the effects of graded levels of woodchip on the performance and behaviour of feedlot cattle housed in wet pen conditions. Bos taurus steers (n = 300; 379.1 ± 24.1 kg) were blocked by weight and breed and randomly assigned to 30 10-steer feedlot pens provided with either no woodchip bedding (Control, n = 10) manure interface only, or 15 cm depth of woodchip bedding (W15, n = 10) or 30 cm depth of woodchip bedding (W30, n = 10). The steers were housed in these treatment pens for 109 days on a feedlot ration, and the pens were irrigated so that approximately 74 mm of total precipitation (irrigation + natural rainfall) fell onto the pen surface every 30 days. Temperatures were mostly <20 °C maximum and -1 to 5 °C minimum. Steers were weighed on five occasions. Animal position and posture in pen were recorded once a week over an 8-hour day-time period. Carcase characteristics were measured, and adrenal gland weights were recorded. Providing woodchip bedding increased liveweight gain (P < 0.001) and gain:feed (G:F, P = 0.012) after day 28, increased DM intake (DMI) after day 92 (P = 0.049), and increased carcase weight (P = 0.001) and dressing percentage (P = 0.023). There was no additional benefit of W30 over W15 for liveweight gain or DMI, but the benefit of W15 for G:F was lower than that of W30 by the end of the feeding period (P = 0.012). There were no effects of bedding on other carcase quality traits. Steers in Control pens utilised the front of the pen for lying and standing more than the W15 and W30 steers (P < 0.001) suggesting the steers in the Control pens perceived the front of the pen as less aversive, potentially due to increased drainage compared to rest of the pen and proximity to feed bunk. Adrenal gland weight/kg and carcase weight tended to be higher in the Control treatment group than the W30 steers (P = 0.077). This research has demonstrated that for a 109-day feeding period in cold, wet conditions, steer performance and welfare can be improved by providing a minimum of 15 cm woodchip bedding.

Terahertz radiation of microcavity dipolaritons

We propose the use of dipolaritons-quantum well excitons with a large dipole moment, coupled to a planar microcavity-for generating terahertz (THz) radiation. This is achieved by exciting the system with two THz detuned lasers that leads to dipole moment oscillations of the exciton polariton at the detuning frequency, thus generating a THz emission. We have optimized the structural parameters of a system with microcavity embedded AlGaAs double quantum wells and shown that the THz emission intensity is maximized if both of the laser frequencies match different dipolariton states. The influence of the electronic tunnel coupling between the wells on the frequency and intensity of the THz radiation is also investigated, demonstrating a trade-off between the polariton dipole moment and the Rabi splitting.

Risk factors associated with preterm birth after a prior term delivery

OBJECTIVE

The objective of this study was to assess the presence of newly acquired preterm birth (PTB) risk factors among primiparous women with no prior history of PTB.

DESIGN

Case-control study.

SETTING

Deliveries occurring within a large healthcare system from 2002 to 2012.

POPULATION

Women with their first two consecutive pregnancies carried to ≥20(0/7)  weeks' gestation.

METHODS

Those delivering the first pregnancy at term and the second preterm ≥20(0/7) and <37(0/7)  weeks (term-preterm cases) were compared with women with a term birth in their first two pregnancies (term-term controls). Social factors with the potential to change between the first and second pregnancies and intrapartum labour characteristics in the first pregnancy were compared between cases and controls.

MAIN OUTCOME MEASURES

Risk factors for term-preterm sequence.

RESULTS

About 38 215 women met inclusion criteria; 1353 (3.8%) were term-preterm cases. Cases and controls were similar with regard to race/ethnicity and maternal age at the time of the first and second deliveries. Cases delivered their second pregnancy approximately 3 weeks earlier (35.7 versus 39.1, P < 0.001). In multivariable models accounting for known PTB risk factors, women with a caesarean delivery in the first pregnancy [adjusted odds ratio (aOR) = 2.20; 95% confidence interval (CI) 1.57-3.08], new tobacco use (aOR = 2.33; 95% CI 1.61-3.38), and an interpregnancy interval <18 months (aOR = 1.37; 95% CI 1.21-1.55) were at increased risk of term-preterm sequence.

CONCLUSION

Caesarean delivery in the first pregnancy, new tobacco use, and short interpregnancy interval <18 months are significant risk factors for term-preterm sequence. Women should receive postpartum counselling regarding appropriate interpregnancy interval and cessation of tobacco use.

TWEETABLE ABSTRACT

Caesarean delivery in the 1st pregnancy is a significant risk factor for preterm birth following a term delivery.

Consensus guidelines for optimising antifungal drug delivery and monitoring to avoid toxicity and improve outcomes in patients with haematological malignancy, 2014

Antifungal agents may be associated with significant toxicity or drug interactions leading to sub-therapeutic antifungal drug concentrations and poorer clinical outcomes for patients with haematological malignancy. These risks may be minimised by clinical assessment, laboratory monitoring, avoidance of particular drug combinations and dose modification. Specific measures, such as the optimal timing of oral drug administration in relation to meals, use of pre-hydration and electrolyte supplementation may also be required. Therapeutic drug monitoring (TDM) of antifungal agents is warranted, especially where non-compliance, non-linear pharmacokinetics, inadequate absorption, a narrow therapeutic window, suspected drug interaction or unexpected toxicity are encountered. Recommended indications for voriconazole and posaconazole TDM in the clinical management of haematology patients are provided. With emerging knowledge regarding the impact of pharmacogenomics upon metabolism of azole agents (particularly voriconazole), potential applications of pharmacogenomic evaluation to clinical practice are proposed.

Drift-diffusion model of the fragmentation of the external ring structure in the photoluminescence pattern emitted by indirect excitons in coupled quantum wells

Under optical excitation, coupled quantum wells are known to reveal fascinating features in the photoluminescence pattern originating from dipole orientated indirect excitons. The appearance of an external ring has been attributed to macroscopic charge separation in the quantum well plane. We present a classical model of nonlinear diffusion to account for the observed fragmentation of the external ring into a periodic array of islands. The model incorporates the Coulomb interactions between electrons, holes, and indirect excitons. At low temperatures, these interactions lead to pattern formation similar to the experimentally observed ring fragmentation. The fragmentation is found to persist to temperatures above the quantum degeneracy temperature of indirect excitons.

Electrostatic conveyer for excitons

We report on the study of indirect excitons in moving lattices-conveyers created by a set of ac voltages applied to the electrodes on the sample surface. The wavelength of this moving lattice is set by the electrode periodicity, the amplitude is controlled by the applied voltage, and the velocity is controlled by the ac frequency. We found the dynamical localization-delocalization transition for excitons in the conveyers and determined its dependence on exciton density and conveyer amplitude and velocity.

[How did youths deal with their forced sterilisation during the Third Reich? Report of a physician involved]

In 1933, one of the first laws passed by the Nazis in Germany was that to prevent the birth of children with hereditary diseases, which legalised forced sterilisation in Germany and also applied to minors. On Social Welfare Education Day in 1934, the leading physician at the "Anstalt Bethel" (Bethel Institution), Werner Villinger, gave a speech on the experience of sterilisation. A main part of his speech was the description of the reaction, fears, and resistance of the boys involved, and the accuracy of his observations stands in sharp contrast to the ruthlessness of the performance of the sterilisation, which was rooted in unshakeable faith in the necessity of this measure.

Distal margin requirements after preoperative chemoradiotherapy for distal rectal carcinomas: are < or = 1 cm distal margins sufficient?

BACKGROUND

Sphincter-sparing alternatives to abdominoperineal resection (APR) in the treatment of rectal cancer often are underused out of concern for inadequate distal margins and local failure. The present study addresses whether sphincter-sparing techniques with distal margins < or = 1 cm adversely influence oncological outcome in patients given preoperative chemoradiotherapy.

METHODS

Thirty-seven patients with rectal cancer < or = 8 cm from the anal verge were enrolled in the study. Preoperative external beam radiotherapy (5400 Gy) was administered together with continuous infusion of 5-fluorouracil (300 mg/m2/day). Surgical resection was performed in 36 patients with pathological assessment of tumor response and margins. Patients with sphincter-sparing resection and distal margins > 1 cm or < or = 1 cm and those who underwent APR were compared.

RESULTS

Thirty-six patients completed preoperative chemoradiotherapy, with successful sphincter-preservation in 28 patients. At a median follow-up of 33 months, there were 12 recurrences overall, which included 11 distant failures and four pelvic failures. Disease-free survival (DFS) was not different between those who had an APR compared with sphincter-sparing resection with distal margins < or = 1 cm. DFS was worse (P < .02) when radial margins were < or = 3 mm compared with > 3 mm.

CONCLUSIONS

Sphincter preservation is feasible in more than 75% of patients with tumors < or = 8 cm from the anal verge after preoperative chemoradiotherapy. Sphincter-sparing surgery with distal margins < or = 1 cm can be used without adversely influencing local recurrence or DFS. Limited radial margins (< or = 3 mm), however, are associated with increased disease recurrence.

[The psychology of compassion. An analysis of the 100th anniversary of the death of Fredrich Nietzsche]

Friedrich Nietzsche is supposed to have been one of the harshest critics of compassion. Many of his publications try to unmask its failings and to expose its true motives. From an ardent admirer of Schopenhauers's ethics of compassion, Nietzsche turned into a vigorous despiser of compassionate feelings. It is shown that this change was above all caused by overwhelming personal experiences of compassion due to illness and death in his family and, later on, with his first aid activities in military hospitals during the German-French war in 1870. Combined with that, Nietzsche suffered from feelings of passivity and helplessness, which gave him the impression of compassion being a negative and--in the end--loathed emotion.

[Friedrich Nietzsche: history of his illness. On the 100th anniversary of the death of the poet-philosopher]

The philosopher Friedrich Nietzsche was one of the most famous patients in the psychiatric hospital Jena. Between 1889 and 1890, Otto Binswanger und Theodor Ziehen treated the progressive paralysis of Friedrich Nietzsche whose 100th anniversary of death is on 25th August 2000. After Nietzsche's death, an animated discussion about his disease arose. Many objected against the syphilitic diagnosis of the disease. Nietzsche's medical fill became a popular object of science, although it ended as a very odd story.

Primary extra-nodal lymphoma of the urinary bladder

Primary non-Hodgkin's lymphoma of the urinary bladder is rare. Only a few cases have been reported. We report the case of a woman with non-Hodgkin's lymphoma of urinary bladder and review the literature.

[Comparison of WISC-R and Raven's Progressive Matrices tests in a clinical consultation population]

OBJECTIVES

What are the differences between measuring intelligence with the WISC-R or with the Progressive Matrices Tests?

METHODS

702 children were tested as outpatients of the Child and Adolescent Department of the Psychiatric University Hospital Erlangen-Nuremberg by means of the WISC-R and the Progressive Matrices Tests (CPM and SPM).

RESULTS

Highly significant differences in the mean were found. The mean IQ was 10 points higher on the CPM than on the WISC-R but 6 points lower than the WISC-R on the SPM. At 0.67 the correlations between WISC-R and the Matrices Tests were each in the middle high range. Differences between the tests were substantial and remain unchanged despite the recently newly normed SPM.

[The young Heine. Case history of pseudologia phantastica]

The young Heinrich Heine showed signs of pseudologia phantastica. While studying the diaries of his greatuncle, he identified with the latter. The underlying factors of this psychopathological development are discussed in this paper.

[Co-responsibility in suicide? Coping with grief and guilt by Johann Wolfgang von Goethe]

Under the presumption of having promoted some young people's suicides by publishing his novel "Werther", Goethe was deeply affected by the suicide of Christiane von Lassberg, the 28-year old daughter of a Weimarian officer. The subject of this essay is to investigate how Goethe worked on the mental conflict of guilt and grief and how he counteracted the danger of paralysing depressions by active intervention and which form of literary expressions he chose.

Long-term occurrence of Trypanosoma congolense resistant to diminazene, isometamidium and homidium in cattle at Ghibe, Ethiopia

Ten trypanosome isolates were collected at random from cattle at Ghibe, Ethiopia, in February 1993 and all shown to be savannah-type Trypanosoma congolense. When inoculated into naïve Boran (Bos indicus) calves, all 10 isolates were resistant to diminazene aceturate (Berenil), isometamidium chloride (Samorin) and homidium chloride (Novidium) at doses of 7.0 mg/kg body weight (b.w.), 0.5 mg/kg b.w. and 1.0 mg/kg b.w., respectively. In order to determine whether this multiple-drug resistance was expressed by individual trypanosomes, clones were derived from two of the isolates and characterised in mice for their sensitivity to the three compounds; by comparison to drug-sensitive populations, the two clones expressed high levels of resistance to all 3 trypanocides. In experiments to characterise the uptake kinetics of [14C]-Samorin, the maximal rates of uptake (Vmax) for 4 Ghibe isolates ranged from 9.2 to 15.0 ng/10(8) trypanosomes/min. In contrast, Vmax for the isometamidium-sensitive clone T. congolense IL 1180 was 86.7 +/- 8.6 ng/10(8) trypanosomes/min. Lastly, molecular karyotypes were determined for eight isolates: seven different chromosome profiles were observed. These data indicate that in February 1993 there was a high prevalence of drug-resistant trypanosome populations with different chromosome profiles in cattle at Ghibe. Since a similar situation existed at the same site in July 1989, this suggests that the drug-resistance phenotype of trypanosomes at Ghibe had not altered over a 4 year period.

[God is dead--Friedrich Nietzsche's Oedipus complex]

The early psychoanalysts were influenced by the philosophical ideas of FRIEDRICH NIETZSCHE. The work of SIGMUND FREUD was partly based on NIETZSCHE'S literary world. Just before his mental disaster NIETZSCHE radically destroyed once precious ideals. The roots of this provocative development will be elucidated by analyzing NIETZSCHE'S childhood. A main aspect is NIETZSCHES close mother-tie and especially his father's early death. The father-image of NIETZSCHE'S late years is an essential of this paper.

[Eros and thanatos in the life and work of Heinrich Heine--a study on the occasion of the 200th birthday of the poet]

Themes of love and death in combination determine Heinrich Heines early lyrics. Heine's psychosexual development ist analyzed by emphasising the female influence. His fantasies during adolescence, masochistic tendencies and his inclination to duels are highlighted by referring to Freud's concept of eros and thanatos.

Human herpes virus-6 infection in marrow graft recipients: role in pathogenesis of graft-versus-host disease. Newcastle upon Tyne Bone Marrow Transport Group

To investigate the hypothesis that target organ infection with human herpes virus-6 (HHV-6) exacerbates the clinical severity of GVHD, skin and rectal biopsies from 34 allogeneic bone marrow transplant (BMT) recipients and 23 comparative autologous recipients were studied. Biopsies and heparinised blood samples were obtained from all patients prior to and at regular intervals after BMT, and whenever GVHD was suspected. HHV-6 antigen was detected in cryostat sections by immunohistochemistry, and HHV-6 DNA in peripheral blood leucocytes (PBL) and biopsies by nested PCR. Twenty-eight (90%) of the 31 patients who engrafted developed clinical GVHD, which was mild in five, moderately severe in nine and severe in 14. Overall, HHV-6 DNA was detected in PBl in 74% of autologous recipients and 76% of allogeneic recipients, and in biopsy tissue in 48% of autos and 71% of allos. However, HHV-6 DNA was detected in skin and/or rectal biopsies more frequently in allogeneic recipients with severe GVHD (92%) than in those with either moderate (55%) or mild GVHD (22%), suggesting an association (P = 0.004) between HHV-6 DNA in biopsy tissue and GVHD severity. A significant linear trend (P = 0.03) was identified between detection of HHV-6 DNA in biopsy tissue obtained prior to or concomitant with the onset of GVHD and increased GVHD severity, suggesting that HHV-6 was causally linked to GVHD rather than reactivated as a consequence of GVHD therapy. Thus this study supports a role for HHV-6 in the initiation and/or exacerbation of GVHD, and suggests that the presence of HHV-6 DNA in the skin or rectum may be a factor in determining GVHD severity. If confirmed, these findings may have implications for the management of allogeneic BMT recipients.

Cytotoxicity, cellular accumulation and DNA binding of oxaliplatin isomers

Oxaliplatin (trans-l-1,2-diaminocyclohexane oxalato Pt(II); 1R,2R-dach, l-OHP), its trans-d isomer (1S,2S-dach) and cis-dach (1R,2S-dach) isomers were compared in in vitro testing against human ovarian carcinoma cell lines A2780, A2780/CP (cisplatin resistant), A2780/l-OHP (oxaliplatin resistant), colon carcinoma cell line HT-29, and murine leukemia cell lines L1210, L1210/CP (cisplatin resistant), and L1210/dach (tetraplatin resistant). The relative molar potency of the three complexes in all the cell lines except A2780/l-OHP and L1210/dach are trans-l > trans-d > cis-dach; in A2780/l-OHP they are trans-l = trans-d > cis-dach; in L1210/dach trans-l > trans-d = cis-dach. The A2780/l-OHP selected for trans-l resistance is 3.6-fold resistant to oxaliplatin, showed no resistance to trans-d isomer and is 6-fold resistant to cis-dach. However, L1210/dach which is selected for carboxyphthalato 1,2-dach (trans-dl) platinum(II) is 140-fold resistant to oxaliplatin, 73-fold resistant to trans-d, and 41-fold resistant to cis-OHP. The accumulation and DNA binding of platinum following a 2-h treatment of A2780 cells with each of the isomers (60 microM) is in the order of trans-l > cis-dach > trans-d which corresponded to the cytotoxicity of trans-l, but not the others. The data suggest that other processes, such as differential formation of specific adducts and/or repair may be involved. Of the three isomers l-OHP is the superior and its accumulation and DNA binding are consistent with its cytotoxicity.

Role of target organ infection with cytomegalovirus in the pathogenesis of graft-versus-host disease

Skin and rectal biopsy tissue from 34 allogeneic and 23 autologous BMT recipients was prospectively analysed for CMV using immunohistochemistry and PCR to investigate the hypothesis that target organ infection with CMV initiates and/or exacerbates GVHD. Biopsies were obtained prior to and at 3, 8 and 26 weeks after BMT and whenever GVHD was suspected. Surveillance specimens of peripheral blood leucocytes (PBL), urine and throat swabs were obtained every 2 weeks until 12 weeks after BMT, and whenever CMV was suspected. Cryostat sections were analysed immunohistochemically for CMV antigens and PBL and biopsies for CMV DNA by PCR. Of the 31 patients who engrafted, 28 (90%) developed GVHD clinically, confirmed histologically in 56 biopsies. GVHD proved clinically severe in 14 patients, 4 of whom had treatment-resistant GVHD. CMV was detected in PBL more frequently in patients with severe GVHD than in those with mild/moderate GVHD (29% vs. 7%). However, in all but one patient the onset of GVHD preceded detection of CMV. In biopsy specimens, CMV was detected in only 2 patients, 1 of whom had an exacerbation of GVHD temporally associated with CMV. Thus, despite a high incidence of GVHD in this series, with 56 episodes of GVHD in 28 patients, only 1 patient had CMV in biopsy tissue temporally associated with GVHD. This suggests that biopsy infection with CMV is not a major factor in initiating or exacerbating GVHD in this cohort. This study thus does not support a role for target organ infection with CMV in the pathogenesis of GVHD.

Differentiation of materno-fetal GVHD from Omenn's syndrome in pre-BMT patients with severe combined immunodeficiency

Materno-fetal GVHD is commonly a fatal condition occurring in patients with severe combined immunodeficiency (SCID). Definitive diagnosis is often difficult. We describe a patient with clinical features suggestive of materno-fetal GVHD but in whom histology was atypical. Y chromosome-specific PCR amplification analysis of DNA extracted from the skin biopsy was performed to detect chimeric evidence of infiltrating maternal T cells. This revealed strong positivity for the Y chromosome, indicating lack of maternal T cell engraftment and thus confirming a diagnosis of Omenn's syndrome, a variant of SCID in which atypical lymphocyte clones give rise to a similar picture. In contrast, Y chromosome-specific PCR analysis of skin biopsy DNA from a male patient with a rash clinically and histologically typical of materno-fetal GVHD revealed absence of the Y chromosome, indicating infiltration of maternal cells and thus confirming the diagnosis of materno-fetal GVHD. Y chromosome-specific PCR analysis is thus a useful investigation for the differentiation of materno-fetal GVHD from Omenn's syndrome in pre-BMT SCID patients presenting with unexplained rash.

MHC class II and ICAM-1 expression and lymphocyte subsets in transbronchial biopsies from lung transplant recipients

The expression of MHC class II antigens and ICAM-1 and the composition of lymphocyte infiltrates have been studied in frozen sections of transbronchial biopsies from lung transplant recipients. First, biopsies obtained from patients who showed acute rejection, OB, and normal features were compared. Second, we compared first-year biopsies from patients developing OB and patients with a good clinical outcome. HLA-DR was widely expressed on epithelia and vascular endothelium. Increased vascular HLA-DP expression was found in OB biopsies. In OB patients there was a significantly increased frequency of bronchial HLA-DP and vascular HLA-DQ expression. Expression of ICAM-1 by bronchial and bronchiolar basal cells, a phenomenon not reported previously in humans, was seen in a small number of biopsies. CD8 predominant lymphocytic infiltrates were present in all groups and were increased in OB biopsies and OB patients. Increased numbers of CD4-positive cells were found in rejection and OB when compared with normal biopsies. These findings support an immunological basis for the development of OB.

Diagnostic features of transfusion associated graft versus host disease

AIMS

To define the immunopathological profile of transfusion associated graft versus host disease (TA-GvHD) to elucidate its pathophysiology and to determine if any features are of diagnostic value.

METHODS

Nine patients (age range 14-61 years) who developed histologically confirmed TA-GvHD between 1989 and 1992 were studied. Immunohistochemical analysis of frozen and formalin fixed skin biopsy tissue was performed. Sections were stained with antibodies to CD3, CD8, CD4 and HLA-DR, using a routine streptavidin-biotin technique with standard diaminobenzidine development.

RESULTS

All biopsy specimens showed aberrant positive expression of HLA-DR by epidermal keratinocytes. In four patients, all of whom died, HLA-DR was diffusely expressed throughout the epidermis; in the other five cases keratinocyte expression of HLA-DR was more focal. In all biopsy specimens T cells had infiltrated the dermis and epidermis. In all nine cases CD4+ T helper/inducer cells were the predominant T cells.

DISCUSSION

Immunohistochemical studies are of value in the diagnosis of TA-GvHD. Aberrant keratinocyte expression of HLA-DR and dermal and epidermal infiltration of CD4+ T cells are immunopathological features of TA-GvHD. Immunohistochemical analysis of skin biopsy tissue using antibodies to these markers is thus a useful investigation in pancytopenic patients presenting with unexplained rashes.

Late development of graft-versus-host disease in an autologous BMT recipient

Clinical and histological changes consistent with GVHD have been described in recipients of both syngeneic and autologous grafts. The mechanism of autologous GVHD is well documented. However, cases of autologous GVHD previously reported have all occurred within the first 2 months post-BMT. We report the case of an autologous BMT recipient in whom histological features consistent with GVHD emerged 7 months post-BMT, which may have implications for the long-term follow-up of autologous marrow graft recipients.

Constitutive expression of MHC and adhesion molecules by alveolar epithelial cells (type II pneumocytes) isolated from human lung and comparison with immunocytochemical findings

Highly purified populations of alveolar epithelial cells (type II pneumocytes) were isolated from human lung specimens. These cells were characterised histochemically, by demonstrating the presence of intracellular alkaline phosphatase, and morphologically, by electron microscopic demonstration of lamellar bodies and microvilli. Expression of the epithelial glycoprotein HEA-125, of MHC class I and class II (HLA-DR, -DP and -DQ) antigens and of the intercellular adhesion molecules ICAM-1, VCAM-1, LFA-3 and B7 was quantified by flow cytometry. Comparison was made between the expression of these molecules by isolated type II cells and by alveolar epithelium in normal human lung tissue after immunocytochemical staining of frozen sections of donor lung. Isolated type II pneumocytes expressed HEA-125 and class I MHC molecules and the class II MHC molecules HLA-DR and -DP; HLA-DQ was not detected. The intercellular adhesion molecule ICAM-1 was expressed constitutively at low levels but there was minimal expression of VCAM-1, LFA-3 and B7. It was not possible to differentiate type II cells from the predominant type I pneumocytes on frozen sections. Alveolar epithelium expressed HEA-125, class I MHC antigens, the class II molecules HLA-DR, and -DP and the intercellular adhesion molecule LFA-3. Expression of the adhesion molecules ICAM-1, VCAM-1 and B7 was variable. As with the isolates, HLA-DQ was not observed on alveolar epithelium. In conclusion, a reproducible method for the isolation of pure populations of human type II pneumocytes has been developed. These cells were not damaged by the isolation procedure. It is not known whether alveolar epithelium can present antigens to T lymphocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Psychomotor delay and psychiatric diagnoses in special education students]

76 first grade children of a special school for learning disabled were tested for specific developmental disorders of motor functions (SDDM). 15 children (19.7%), boys and girls proportionately, had a SDDM. This is a substantial increase compared to the unselected population. 8 children (15.5%) suffered from a specific disorder of body coordination and low finger-eye coordination. 4 children (5.3%) were found to have specific disorders of motor functions and specific language retardations. Isolated disorders of hand coordination were not found. 31% of the children with SDDM suffered from psychiatric disorders. Roughly the same percentage of psychiatric diagnosis was found in children without disorders of motor functions. A total of 24 children (33%) had impaired physical coordination: these children had significantly higher total scores in the Child Behavior Checklist (CBCL). Though this questionnaire was not sensitive for detection of disorders of motor functions.

[Reliability of the Child Behavior Checklist in a population of 6 to 8-year-old special education students]

66 children attending first grade at a special school for educationally subnormal children were examined medically and psychologically. Classification was done according to ICD-10. In addition, the parents were asked to rate their children's behavior with the "Child Behavior Checklist" by Achenbach and Edelbrock. The most common symptoms rated in this group of 6- to 8-year-old children were lack of concentration, speech and language problems, hyperactivity, demand for attention and arguing. The mean total score (cut-off score: 30) and the number of crucial items (cut-off score: at least two crucial items) differed significantly between the children with and those without psychiatric disorders. No significant correlation was found between the mean total score or the number of crucial items and the sex of the children or the other axes of the Multi-axial Classification of Child Psychiatric Disorders.

Fluorescence analysis of the interaction of isometamidium with Trypanosoma congolense

Isometamidium chloride (Samorin) is the only compound recommended for prophylaxis against bovine trypanosomiasis in sub-Saharan Africa. The fluorescence property of this compound was used to investigate the interaction of the molecule with in vitro-derived bloodstream forms of Trypanosoma congolense IL 1180. Incubation of isometamidium with trypanosomes at 37 degrees C for 180 min resulted in a gradual alteration of the lambda max. with time (from 600 to 584 nm) and an increase in the intensity of trypanosome-associated fluorescence of approx. 2-fold. The alteration in fluorescence was temperature-dependent and inhibited by the addition of N-ethylmaleimide. In contrast, with intact cells addition of digitonin caused a rapid increase in fluorescence intensity to approximately four times that observed with intact cells. Uptake of isometamidium was also determined using radiolabelled drug; the results indicated that the time course of the uptake process resembled the fluorescence profile and was temperature-dependent. The results therefore indicate that the alteration of fluorescence is due to interaction of isometamidium with an intracellular component(s) and that isometamidium is transported across the plasma membrane via a protein carrier. The data also indicate that the described fluorescence technique can be used to investigate the role of membrane transport in resistance to isometamidium.

[Specific delays of language development in special education students]

The frequencies of specific language retardation and deficits in short term memory span are the subject of this epidemiological investigation of children attending the first grade of a special school for educationally subnormal children in Erlangen and München/Rosenheim. The children at the mean age of seven were examined according to the "Multi-axial Classification of Child Psychiatric Disorders". The following prevalences were found: 16 children (21%) of the sample from Erlangen and 24 children (33%) of the sample from München/Rosenheim had an specific language retardation, in both sample the most frequent disorders were retardations of the expressive language (11% and 21%). In both sample most children had substantially deficits in the acoustic short term memory span, while they were better on visual short term memory span. Significant correlations between acoustic short term memory span and specific language retardations were found.

[Multiple diagnoses and stresses in children of primary school age]

The study was conducted to assess the consequences of multiple diagnoses and handicaps in children aged 6 to 8 years. Children were considered to be "multiply handicapped" if they suffered from two or more disorders or impairments included in the Multi-axial Classification Scheme. To this end children in special schools were compared with a random sample of children from three communities in Bavaria. As expected, all prevalences found in the population of children from special schools were substantially higher than those found in the random sample. Furthermore, the proportion of children with multiple handicaps in the special schools far exceeded what one would have expected based on the findings for the random sample. Most of the disturbances did not differ in respect to their comorbidity. But the mentally retarded children in the special schools were all "multiply handicapped". The importance of "multiple handicaps" for the assignment to special schools is discussed, as are the implications for the planning of services.

Preparative labeling of proteins with [35S]methionine

The most common technique for preparative labeling of proteins with radioisotopes for experimental purposes utilizes 125I. This isotope has certain limitations, including the emission of gamma- and X-irradiation, the release of gaseous 125I2 from solutions of Na 125I, and the potential for concentration of 125I in thyroid glands. We have discovered a means for labeling proteins rapidly and simply with [35S]methionine. The technique is applicable to a wide variety of proteins. Antibodies labeled by our technique remain functional.

Spatial and temporal patterns of intracellular calcium in colonic smooth muscle

Intracellular calcium [Ca2+]i measurements in cell suspension of gastrointestinal myocytes have suggested a single [Ca2+]i transient followed by a steady-state increase as the characteristic [Ca2+]i response of these cells. In the present study, we used digital video imaging techniques in freshly dispersed myocytes from the rabbit colon, to characterize the spatiotemporal pattern of the [Ca2+]i signal in single cells. The distribution of [Ca2+]i in resting and stimulated cells was nonhomogeneous, with gradients of high [Ca2+]i present in the subplasmalemmal space and in one cell pole. [Ca2+]i gradients within these regions were not constant but showed temporal changes in the form of [Ca2+]i oscillations and spatial changes in the form of [Ca2+]i waves. [Ca2+]i oscillations in unstimulated cells (n = 60) were independent of extracellular [Ca2+] and had a mean frequency of 12.6 +/- 1.1 oscillations per min. The baseline [Ca2+]i was 171 +/- 13 nM and the mean oscillation amplitude was 194 +/- 12 nM. Generation of [Ca2+]i waves was also independent of influx of extracellular Ca2+. [Ca2+]i waves originated in one cell pole and were visualized as propagation mostly along the subplasmalemmal space or occasionally throughout the cytoplasm. The mean velocity was 23 +/- 3 microns per sec (n = 6). Increases of [Ca2+]i induced by different agonists were encoded into changes of baseline [Ca2+]i and the amplitude of oscillations, but not into their frequency. The observed spatiotemporal pattern of [Ca2+]i regulation may be the underlying mechanism for slow wave generation and propagation in this tissue. These findings are consistent with a [Ca2+]i regulation whereby cell regulators modulate the spatiotemporal pattern of intracellularly generated [Ca2+]i oscillations.

Monocytic leukemoid reaction, glucocorticoid therapy, and myelodysplastic syndrome

A leukemoid reaction is a complex and poorly understood response by the bone marrow to a variety of stresses; although any peripheral blood cell line may be involved, it is rarely a purely monocytic event. A case is reported of a true monocytic leukemoid reaction in a patient with myelodysplastic syndrome related to the effect of corticosteroids on the underlying marrow disorder.

Isokinetic evaluation of shoulder rotational strength between the plane of scapula and the frontal plane

The purpose of this study was to determine whether shoulder rotational strength was greater in the plane of the scapula or the frontal plane. Isokinetic shoulder rotational strength was evaluated in 20 subjects. Using the Merac (Universal Gym Equipment, Inc., Cedar Rapids, IA), test data was gathered in the right shoulders, in 45 degrees abduction, at a speed of 60 deg/sec, in the plane of the scapula and the frontal plane. Each subject returned within 1 week for retests to establish reliability. The average correlational coefficient across tests was 0.87. The Merac computer system was used to analyze data. Mean and standard deviations for peak torque to body weight were calculated. A paired t-test was used to examine the difference in the means for internal and external rotation between the two positions. The results indicated no significant difference between the two positions for shoulder internal rotational strength values. However, shoulder external rotational strength values in the plane of the scapula were statistically significantly higher than in the frontal plane (P less than 0.001). These preliminary results suggest isokinetic strength training and testing may be preferable in the plane of the scapula rather than the frontal plane.

Decay of the oocyte-type heat shock response of Xenopus laevis

Xenopus oocytes have a complex heat shock response. During transition of the oocyte into fertilized egg, the heat shock response undergoes several qualitative and quantitative changes culminating in its complete extinction. Heat shock induces oocytes to synthesize four heat shock proteins (hsps): 83, 76, 70, and 57. After ovulation, two additional proteins (hsps 22 and 16) are inducible. The heat shock response of spawned eggs can be modified by changing the ionic configuration of the external medium and by adding pyruvate and oxaloacetate to the media. Since Xenopus eggs do not synthesize mRNA, these modifications to the external medium apparently alter the utilization of preexisting messenger RNAs in protein synthesis. Artificial activation terminates inducibility of hsps 76, 57, and 16 and diminishes the hsp 70 response. Two new heat shock proteins-66 and 48-are also inducible in artificially activated eggs. Fertilization, on the other hand, terminates the heat shock response; no hsps can be induced. However, hsp 70 appears to be made constitutively in fertilized eggs. RNA blot analyses reveal that oogenic hsp 70 messenger RNA is retained in eggs and early embryos. This messenger is apparently used for heat-induced synthesis of hsp 70 before fertilization and for constitutive synthesis of hsp 70 in zygotes.