Erector spinae plane block vs. peri-articular injection for pain control after arthroscopic shoulder surgery: a randomised controlled trial

Interscalene brachial plexus block is the standard regional analgesic technique for shoulder surgery. Given its adverse effects, alternative techniques have been explored. Reports suggest that the erector spinae plane block may potentially provide effective analgesia following shoulder surgery. However, its analgesic efficacy for shoulder surgery compared with placebo or local anaesthetic infiltration has never been established. We conducted a randomised controlled trial to compare the analgesic efficacy of pre-operative T2 erector spinae plane block with peri-articular infiltration at the end of surgery. Sixty-two patients undergoing arthroscopic shoulder repair were randomly assigned to receive active erector spinae plane block with saline peri-articular injection (n = 31) or active peri-articular injection with saline erector spinae plane block (n = 31) in a blinded double-dummy design. Primary outcome was resting pain score in recovery. Secondary outcomes included pain scores with movement; opioid use; patient satisfaction; adverse effects in hospital; and outcomes at 24 h and 1 month. There was no difference in pain scores in recovery, with a median difference (95%CI) of 0.6 (-1.9-3.1), p = 0.65. Median postoperative oral morphine equivalent utilisation was significantly higher in the erector spinae plane group (21 mg vs. 12 mg; p = 0.028). Itching was observed in 10% of patients who received erector spinae plane block and there was no difference in the incidence of significant nausea and vomiting. Patient satisfaction scores, and pain scores and opioid use at 24 h were similar. At 1 month, six (peri-articular injection) and eight (erector spinae plane block) patients reported persistent pain. Erector spinae plane block was not superior to peri-articular injection for arthroscopic shoulder surgery.

A Retrospective Cohort Study of Total Colonic Aganglionosis: Is the Appendix a Reliable Diagnostic Tool?

Background: Hirschsprung's disease (HD) is characterized by a lack of ganglion cells in the myenteric and submucosal plexus, associated with increased numbers of acetyl cholinesterase (AChE) positive nerve fibres. In approximately 10% of patients with HD the entire colon will be affected; a condition known as Total Colonic Aganglionosis (TCA). Aganglionosis of the appendix has long been considered to be an important finding in a patient in whom TCA is suspected, but its reliability for diagnosis has seldom been discussed. The aim of our study was to assess the reliability of the appendix as a histological specimen for the diagnosis of TCA, and to evaluate the long-term outcome of TCA.

Methods: A retrospective cohort study was performed of all pathological specimens of patients with confirmed HD in our institution between March 2006 and April 2016.

Results: Out of a total of 91 patients identified, 15 patients also had histopathological analysis of the appendix. Nine of these cases were confirmed as having TCA. The remaining 6 patients had HD involving the rest of the bowel up to the ascending colon, with normal ganglion present in the caecum. The appendix was removed in all the 15 cases. All 9 patients with confirmed TCA had aganglionosis of the appendix as well. The remaining 6 cases of short and long segment HD not involving the caecum, demonstrated normal ganglion cells within the appendix.

Conclusion: Aganglionosis of the appendix is a reliable tool in the diagnosis of TCA. The authors recommend that at the time of levelling biopsies, if aganglionosis extends to the mid-transverse colon, an ileostomy be performed and appendix sent for definitive confirmation of TCA. However, at the time of definitive surgery, a frozen section of pull-through segment of bowel is recommended to confirm the presence of ganglion cells.

Age-related mutations and chronic myelomonocytic leukemia

Chronic myelomonocytic leukemia (CMML) is a hematologic malignancy nearly confined to the elderly. Previous studies to determine incidence and prognostic significance of somatic mutations in CMML have relied on candidate gene sequencing, although an unbiased mutational search has not been conducted. As many of the genes commonly mutated in CMML were recently associated with age-related clonal hematopoiesis (ARCH) and aged hematopoiesis is characterized by a myelomonocytic differentiation bias, we hypothesized that CMML and aged hematopoiesis may be closely related. We initially established the somatic mutation landscape of CMML by whole exome sequencing followed by gene-targeted validation. Genes mutated in ⩾10% of patients were SRSF2, TET2, ASXL1, RUNX1, SETBP1, KRAS, EZH2, CBL and NRAS, as well as the novel CMML genes FAT4, ARIH1, DNAH2 and CSMD1. Most CMML patients (71%) had mutations in ⩾2 ARCH genes and 52% had ⩾7 mutations overall. Higher mutation burden was associated with shorter survival. Age-adjusted population incidence and reported ARCH mutation rates are consistent with a model in which clinical CMML ensues when a sufficient number of stochastically acquired age-related mutations has accumulated, suggesting that CMML represents the leukemic conversion of the myelomonocytic-lineage-biased aged hematopoietic system.

A coiled-coil mimetic intercepts BCR-ABL1 dimerization in native and kinase-mutant chronic myeloid leukemia

Targeted therapy of chronic myeloid leukemia is currently based on small-molecule inhibitors that directly bind the tyrosine kinase domain of BCR-ABL1. This strategy has generally been successful, but is subject to drug resistance due to point mutations in the kinase domain. Kinase activity requires transactivation of BCR-ABL1 following an oligomerization event, which is mediated by the coiled-coil (CC) domain at the N-terminus of the protein. Here, we describe a rationally engineered mutant version of the CC domain, called CC^mut3, which interferes with BCR-ABL1 oligomerization and promotes apoptosis in BCR-ABL1-expressing cells, regardless of kinase domain mutation status. CC^mut3 exhibits strong pro-apoptotic and anti-proliferative activity in cell lines expressing native BCR-ABL1, single kinase domain mutant BCR-ABL1 (E255V and T315I) or compound mutant BCR-ABL1 (E255V/T315I). Moreover, CC^mut3 inhibits colony formation by primary CML CD34⁺ cells ex vivo, including a sample expressing the T315I mutant. These data suggest that targeting BCR-ABL1 with CC mutants may provide a novel alternative strategy for treating patients with resistance to current targeted therapies.

A single nucleotide polymorphism in the coding region of ABL and its effects on sensitivity to imatinib

We have identified a gene polymorphism (K247R) within or close to the P-loop of BCR-ABL, which leads to the substitution of arginine for lysine. We investigated the allelic frequency of K247R by screening 157 CML patients and 213 healthy blood donors with conventional sequencing, restriction enzyme digest and single strand conformational polymorphism analysis, and found the arginine allele to be rare. Three out of five CML patients with the arginine allele of K247R failed to achieve a major cytogenetic response to imatinib, suggesting that the arginine allele may have reduced sensitivity. However, despite K247R's position in or near to the P-loop, biochemical and cellular assays of imatinib and dasatinib sensitivity showed no alteration compared to wild type. Clinicians should be aware that possession of the arginine allele of K247R does not reflect a mutation that necessitates a change in the therapeutic strategy, unless there are other signs of inadequate response to drug.

Upper airway EMG responses to acute hypoxia and asphyxia are impaired in streptozotocin-induced diabetic rats

Obstructive sleep apnoea (OSA) is a major clinical disorder that is characterised by multiple episodes of upper airway obstruction due to failure of the upper airway dilator muscles to maintain upper airway patency. The incidence of OSA is high in many endocrine disorders including both insulin-dependent and non-insulin-dependent diabetes but the reasons for this are not known. We wished to test the hypothesis that central respiratory motor output to the upper airway muscles is preferentially impaired in a rat model of diabetes mellitus. Sternohyoid (SH) and diaphragm (DIA) EMG activities were recorded in control and streptozotocin (STZ)-induced diabetic rats during normoxia, hypoxia (7.5% O2 in N2) and asphyxia (7.5% O2 and 3% CO2) under pentobarbitone anaesthesia. SH EMG responses to acute hypoxia and asphyxia were significantly impaired in STZ-induced diabetic rats compared to control animals (+47.1 +/- 5.7 vs. +11.7 +/- 1.9% during hypoxia in control and diabetic animals respectively and +56.5 +/- 7.9 vs. +15.7 +/- 5.0% during asphyxia). However, DIA EMG responses to hypoxia and asphyxia were not different for the two groups. We propose that the higher prevalence of OSA in diabetic patients is related to preferential impairment of cranial motor output to the dilator muscles of the upper airway in response to physiological stimuli.

Co-occurring psychosocial distress and substance abuse in community clients: initial validity and reliability of self-report measures

The current study examines the self-reports of 227 community support clients using a paper and pencil questionnaire that included the South Shore Problem Inventory-revised (a brief multidimensional psychosocial distress scale), a one-item index of self-rated substance abuse (SRSA), a quantity-frequency index for alcohol consumption (QFI), and a one-item index measuring the frequency of marijuana use. Results support the factor structure and internal consistency of the SSPI-r, and show significant correlations among the substance use indices. Implications for including brief mental health and substance abuse measures are discussed within the context of routine assessment and practice evaluation.

Recovering antibody secretion using a hapten ligand as a chemical chaperone

Engineered antibodies have come to the forefront as research reagents and clinical therapeutics. However, reduced stability or expression levels pose a major problem with many engineered antibodies. As a model for understanding functional consequences of variable region mutation, we have studied the assembly and trafficking of anti-phenylphosphocholine antibodies. Previously, we identified severe secretion defects because of mutations in the heavy chain second complementarity determining region, which is involved in antigen binding. Here we demonstrate that immunoglobulin secretion is increased up to 27-fold by incubating stably transfected PCG1-1 cells with cognate hapten p-nitrophenylphosphocholine. Secretion was unaffected by nonbinding analogs. Radiotracer and metabolic labeling experiments demonstrated specific cellular uptake of p-nitrophenylphosphocholine and increased intracellular heavy and light chain assembly. Brefeldin A inhibited hapten-mediated immunoglobulin secretion but not assembly, indicating that assembly occurs early within the biosynthetic pathway. Recovery of secretion correlated with antigen binding capacity, suggesting that the rescue mechanism involves stabilization of heavy and light chain variable domains. This model system provides the first demonstration that cognate ligands can increase intracellular assembly of functional anti-hapten antibody within mammalian cells and suggests that small molecules of appropriate specificity and affinity acting as chemical chaperones may find application for increasing or regulating immunoglobulin expression.

The College Alcohol Problems Scale

A short, reliable two-factor instrument measuring drinking-related negative consequences was developed from a previous measure using two samples of college students. In Study I, data on alcohol use and problems associated with alcohol use were collected on 382 introductory psychology students. The original College Alcohol Problems Scale (CAPS) was tested and found to fit the data poorly. Sequential methods were used to develop a revised instrument. Principal components analyses (PCA) on half of the sample were conducted on 20 items written to measure negative consequences related to college student drinking. Results indicated a two-factor solution measuring social and emotional problems. Confirmatory factor analyses (CFA) on the other half of the sample confirmed the two-factor structure. Further refinement of the instrument resulted in the revised CAPS (CAPS-r), an eight-item two-factor scale. In Study II, the response format was altered to coincide with the Young Adult Problem Screening Test. A total of 726 students completed the instrument as part of a university-wide random sample. CFA showed that the hypothesized model fit well across all measures of model fit and the factor structure was invariant across gender. Additional analyses revealed that the scale was internally consistent and externally valid. A short reliable and valid measure of alcohol-related problems is needed to enable low-cost data collection on college campuses across the nation, as well as to facilitate program evaluation and routine epidemiological surveillance and monitoring.

The Drinking Context Scale. A confirmatory factor analysis

The current article examines the development and validation of the Drinking Context Scale through the use of confirmatory factor analysis. The scale measures the self-reported likelihood of excessive drinking across a number of specific social-cognitive drinking contexts. Five-hundred-and-five college students adjudicated for breaking university drinking rules filled out the anonymous questionnaire. Three factors including convivial, intimate, and negative coping contexts were confirmed, and these factors demonstrated good reliability and evidence of concurrent validity with other substance abuse indices, including the Alcohol Use Disorders Identification Test and the College Alcohol Problem Scale. Implications for the DCS as an assessment tool for prevention and early intervention with young people are discussed.

Evidence of progressive delay of motor development in children with sensorineural hearing loss and concurrent vestibular dysfunction

Gross motor development, and the effect of age, sex and vestibular function on it, was examined in 39 24- to 83-mo.-old children with sensorineural hearing impairment. Repeated testing was completed on 18 children. Delayed gross motor development was evident regardless of age, but only children less than 5 years of age had developmental balance deficits on initial testing. Both gross motor and balance development scores were lower on repeated testing. Furthermore, vestibular function scores facilitated identification of those children with a deficit in balance development as well as those with a progressive delay in motor or balance development. Implications for practice are discussed.

Cutting edge: proteasome involvement in the degradation of unassembled Ig light chains

Several studies on disposal of nonsecreted Ig L chains have identified the endoplasmic reticulum as the site of degradation. Here, we examine degradation of a nonsecreted Ig L chain, T15L, and an experimentally endoplasmic reticulum-retained secretion-competent L chain, D16L, in the absence of H chains. We demonstrate that 1) degradation is specifically impaired by the proteasome-specific inhibitors carboxybenzyl-leucyl-leucyl-leucine vinyl sulfone (Z-L3VS) and lactacystin, 2) L chain degradation occurs early in the biosynthetic pathway, and 3) degradation does not require vesicular transport. Our findings indicate that previous assertions of L chain disposal within the endoplasmic reticulum must be modified. To our knowledge, we provide the first direct evidence supporting a new paradigm for removal of nonsecreted Ig L chains via dislocation to cytosolic proteasomes.

Validating the Alcohol Use Disorder Identification Test with college first-offenders

Although the Alcohol Use Disorders Identification Test (AUDIT) has been shown to have good validity and reliability with clinical samples, little data has been examined with respect to youthful problem drinkers, particularly college students. Data collected with 312 students cited their first time for breaking university drinking rules was examined to evaluate the factorial validity and internal consistency of the 10-item scale, and also to test the validity of the AUDIT against two scales designed with a previous cohort specifically to measure hazardous (The Drinking Context Scale) and harmful drinking (the College Alcohol Problem Scale) in college students. Overall, results suggest that the AUDIT is a valid and reliable screening device for college students, and could play an important role in assessing youthful problem drinkers for early intervention programming.

Anterior subannular T-tube for long-term middle ear ventilation during tympanoplasty

OBJECTIVE

A technique for providing long-term ventilation of the middle ear (ME) during tympanoplasty is described, and the results using this technique in 20 patients with chronic Eustachian tube dysfunction (ETD) are reported.

STUDY DESIGN

This study was a retrospective, nonrandomized case review.

SETTING

This study was conducted at an otology clinic in a tertiary referral center.

PATIENTS

Twenty consecutive patients who underwent tympanoplasty with ETD, adhesive otitis media, or chronic otitis media with perforation were included in this study.

INTERVENTION

All patients had a subannular T-tube placed anteriorly at the time of tympanoplasty for long-term ventilation of the ME space.

MAIN OUTCOME MEASURES

The two main outcome measures were tube position and patency. Preoperative and postoperative hearing levels were also tested in most patients, and any complications were documented.

RESULTS

Twenty patients (20 ears) received anterior subannular T-tubes at the time of tympanoplasty. Fourteen females and 6 males were evaluated (median age, 36 years; range, 7 to 72 years). All patients had ETD; 7 had adhesive otitis media, 10 had chronic otitis media, 8 had cholesteatoma, and 2 had cleft palate. All patients had conductive hearing loss and previous surgery. All patients underwent tympanoplasty; 11 had concomitant ossiculoplasty, and 5 had mastoidectomy. Follow-up ranged from 8 to 22 months (mean, 13.4 months). One patient was lost to follow-up. One tube extruded after 16 months. Two patients had persistent mild retraction of the tympanic membrane. All other tubes are patent and have not migrated or plugged. There has been no evidence of anterior blunting or ingrowth of epithelium around the tube.

CONCLUSIONS

Anterior subannular T-tube placement is a simple, safe, and effective alternative for long-term ME ventilation in patients in whom standard transtympanic sites are not available. At their last follow-up visit, all but one patient had a patent tube. All MEs were aerated. This technique offers the advantage of ease of placement during simultaneous tympanoplasty, mastoidectomy, or ossiculoplasty. Longer follow-up is necessary to confirm these initial findings.

Replacements in the exposed loop of the T15 antibody VH CDR2 affect carrier recognition of PC-containing pathogens

A panel of mutant antibodies of the phosphocholine (PC)-binding antibody, T15, was tested for binding to PC-protein, Streptococcus pneumoniae, Trichinella spiralis and Ascaris suum. Relative to wildtype T15, all the mutant antibodies showed differential recognition of the panel of PC-associated antigens. These mutant antibodies contain amino acid replacements in the CDR2 region of the heavy chain variable region, indicating the importance of CDR2 in recognition of carrier determinants. A model of T15 is shown that illustrates the strategic placement of mutations that could allow interaction with determinants associated with PC. A direct implication of this finding is that the T15 antibody combining site accommodates structures larger than phosphocholine and that recognition of associated carrier determinants could be a significant force in shaping the immune response to PC-containing pathogens.

A simple method for determining K(A)s of both low and high affinity IgG antibodies

A rapid and convenient method for measuring affinity constants (K(A)) of IgG antibody-hapten complexes is described. A key advantage of this method is its suitability for quantification of both low and high affinity interactions. A comparison is made of the K(A)s of the low affinity anti-phosphocholine (PC) antibody T15 (K(A) = 2.9 x 10(5) M(-1)) and five heavy chain complementarity determining region 2 (HCDR2) mutant antibodies expressed as IgG2b transfectants. As a demonstration of the general applicability of the technique, colchicine binding to the high affinity monoclonal IgG2a antibody C44 (K(A) = 1.5 x 10(9) M(-1)) is measured also; thus the assay is applicable over a four-log range of affinities. The assay, based upon use of fixed Staphylococcus aureus Cowan I strain cells as an adsorbent for antibody-radiolabeled antigen complexes, is conducted over a range of hapten concentrations at constant antibody concentration. The K(A) is obtained by Scatchard analysis.

Harmful somatic mutations: lessons from the dark side

The ability of somatic mutation to modify the course of an immune response is well documented. However, emphasis has been placed almost exclusively on the ability of somatic mutation to improve the functional characteristics of representative antibodies. The harmful effects of somatic mutation, its dark side, have been far less well characterized. Yet evidence suggests that the number of B cells directed to wastage pathways as a result of harmful somatic mutation probably far exceeds the number of cells whose antibodies have been improved. Here we review our recent findings in understanding the structural and functional consequences of V-region mutation.

Substance abuse among Southeast Asians in the U.S.: implications for practice and research

The literature on Asian-American substance use has shown a general increase in consumption and related problems due, in part, to the effects of acculturation toward U.S. drinking norms. Southeast Asians are the most recent of Asian groups to come to the U.S., and have done so following an immigration and refugee experience that was among the most traumatic in recent memory resulting in significant levels of psychosocial distress. The combined influences of mental health disorders, which frequently co-occur with substance abuse, and acculturation pressures suggest that a significant increase in substance abuse problems may be in progress for Southeast Asian immigrants. Preliminary evidence appears to bear out this hypothesis. The current article outlines the literature on substance abuse among Vietnamese, Cambodians and Laotians in the U.S., and makes tentative recommendations for assessment, treatment and future research.

Measuring problem drinking in first time offenders. Development and validation of the College Alcohol Problem Scale (CAPS)

Research on college drinking continues to justify serious concerns for the psychological, social, and physical well-being of young persons who abuse alcohol. However, despite considerable interest and research in this regard, there are few valid, reliable and clinically useful brief screening instruments available to measure youthful drinking problems. The current study of 315 college students cited their first time for breaking university drinking rules describes the development and validation of the College Alcohol Problem Scale (CAPS) for measuring different psychosocial dimensions of problem drinking in college students. Two related but distinct factors emerged defining Socio-Emotional and Community Problems. These two factors explained almost two thirds of the variance, and showed very good internal reliabilities. MANOVA analysis demonstrated concurrent validity for the CAPS with both a measure of heavy drinking derived from the QFI and a modified version of the MAST. Implications for using the CAPS for identifying potential drinking problems in young persons are emphasized.

Measuring excessive alcohol use in college drinking contexts: the Drinking Context Scale

Research on youthful drinking has shown that the greatest risks associated with alcohol abuse are related to contextual factors that may potentiate heavy drinking as well as increase risks for adverse consequences. These contextual factors include interacting psychological, interpersonal, and environmental dimensions of alcohol use. However, despite considerable college drinking research to identify these factors, few formal instruments have been produced for measuring excessive drinking in multidimensional contexts. The current study of 197 college students who were cited their first time for breaking university drinking rules focuses on the development and validation of a scale for measuring the likelihood of excessive drinking across an array of psychological, interpersonal and situational contexts resulting in the 23-item Drinking Context Scale (DCS). Three distinct factors emerged defining Convivial drinking, Private Intimate drinking, and drinking as a form of Negative Coping. These three factors explained 61.5% of the variance after principal components analysis and varimax rotation, showed excellent internal reliabilities, and were moderately intercorrelated. MANOVA analysis demonstrated concurrent validity with the Quality Frequency Index (QFI) and a modified version of the Michigan Alcoholism Screening Test (MAST). Implications for further research with the DCS are suggested.

Functional characterization of an epidermal growth factor receptor/RET chimera

The RET (recombined in transfection) gene encodes a receptor tyrosine kinase homolog involved in innervation of the gut and renal development. A chimeric epidermal growth factor receptor (EGFR)/RET receptor was constructed which contained the extracellular and transmembrane domains of the EGF receptor fused to the intracellular domain of RET. This construct was expressed in NIH 3T3 cells, and the functional properties of the receptor were characterized and compared with those of the wild type EGF receptor. Whereas the EGF receptor exhibited both high and low affinity binding sites for 125I-EGF, the EGFR/RET chimera exhibited only low affinity binding of 125I-EGF. The chimera was able to internalize EGF more rapidly than the wild type EGF receptor and recycled to the cell surface at twice the rate of the EGF receptor. Pulse-chase experiments indicated that EGF stimulated the degradation of the wild type EGF receptor but had no effect on the rate of degradation of the EGFR/RET receptor. The combination of increased recycling and decreased degradation resulted in the relatively inefficient down-regulation of the EGFR/RET chimera. Incubation of cells expressing the wild type EGF receptor with phorbol 12-myristate 13-acetate led to a reduction in 125I-EGF binding and a loss in EGF-stimulated tyrosine phosphorylation. However, phorbol 12-myristate 13-acetate treatment had only a limited effect on EGF binding and EGF-stimulated tyrosine kinase activity in cells expressing EGFR/RET chimeras. These findings suggest that the ret tyrosine kinase is not regulated by many of the common mechanisms used to terminate signaling via growth factor receptors. Such persistent activation of the Ret tyrosine kinase may be relevant to the physiological function of Ret in cells that normally express this growth factor receptor.

The interest of trainees in working with seriously mentally ill persons

Working with persons who have severe and persistent mental illness has generally not been a preferred career track for prospective mental health professionals. Most of the literature has focused on the recruitment of psychiatrists. This paper reports the results of 78 students in Rhode Island representing three allied mental health professions-social work, psychology, and nursing. Significant differences were found in training environments and learning activities, in interests in working with various diagnostic groups, and in rating the relative importance of both client problems as well as interventions strategies. Implications for future academic-mental health linkages are suggested.

Predicting problem drinking in college students: gender differences and the CAGE questionnaire

Adolescents and young adults are among the highest users of alcohol and other drugs in the United States. One of the tools most commonly employed in screening for problem drinking and alcohol dependence is the CAGE questionnaire. Research has indicated, however, that not only may the CAGE be a poor detection device for identifying youthful substance abuse, but it may particularly lack strength in the detection of alcohol abuse by young women. The current study examined the predictive power of the CAGE relative to other common assessment indicators of youthful substance abuse in a sample of college students. It focused on the relative predictive power of the CAGE in detecting a high level of drinking-related problems. In addition, the interaction of gender and a positive CAGE score was included in the logistic regression analysis to test the hypothesis that the CAGE is predictive for men but not for women. Results suggest that the CAGE is a relatively weak predictor of alcohol-related problems in this sample of college students, and it lacks predictive power for detecting, problems in college women. Issues concerning substance-abuse assessment in young people are discussed, with special consideration given to gender differences.

Kinamycin acetyltransferase I from Streptomyces murayamaensis, an apparently large, membrane-associated enzyme

Identification and initial characterization of an apparently large, membrane-associated multifunctional enzyme, kinamycin acetyltransferase I (KAT I), is described. KAT I activity was enriched 29-fold over the level in cell-free extracts of Streptomyces murayamaensis. Two acetyltransferase activities catalyzing acetyl coenzyme A dependent conversion of kinamycin F and E to kinamycin E and D, respectively, were inseparable in the course of the partial purification. Partial purification involved separation of KAT I from cytosolic proteins by differential ultracentrifugation, solubilization with 0.5% CHAPS zwitterionic detergent followed by ultracentrifugation, and Sephacryl S400 gel filtration chromatography of the resulting supernatant.

Fear of AIDS and homophobia: implications for direct practice and advocacy

Studies of health care trainees and professionals have demonstrated that their level of empathy and caring is negatively affected by the knowledge that the person being treated is homosexual, in part because of stigma associated with HIV infection and AIDS. The survey discussed in this article examined the relationship between homophobia and the fear of AIDS within the context of several categorical questions. Gender differences in attitudes were also examined. Respondents who more liberally endorsed rights for gay men and lesbians were less homophobic and had less fear of AIDS. Suggestions are made for sensitizing social workers to the inhibitory effects of homophobia and fear of AIDS when working with HIV-infected clients or people in the gay community.

Life events and miscarriage

BACKGROUND

The aetiology of miscarriage is poorly understood. The aim of this study is to determine whether women admitted to hospital with miscarriage have experienced more psychosocial stress in early pregnancy than women whose pregnancies progress to labour.

METHOD

Interviews of 48 case-control pairs, matched for known predictors of miscarriage risk, using the Life Events and Difficulties Schedule.

RESULTS

The miscarriage group were more likely to have experienced a "severe life event" in the three months preceding miscarriage (35% v. 15%; P < 005); more likely to have been experiencing a "major social difficulty" (31% v. 4%; P < 0.002); and more likely to have experienced "life events of severe short-term threat" in the fortnight immediately beforehand (31% v. 4%; P < 0.002). Fifty-four per cent of the miscarriage group had experienced at least one of the above indicators of psychosocial stress before miscarrying, compared with 15% of controls (P = 0.0001). Other factors significantly associated with miscarriage included childhood maternal separation; non-UK European origin; poorer reported relationships with partners, and fewer social contacts. CONCLUSION. Psychosocial stress may be a factor in the aetiology of miscarriage. Alternatively, there may be a common determinant (e.g. personality, lifestyle or environmental) predisposing to both stress and miscarriage.

Mental health problems and alcohol abuse: co-occurrence and gender differences

A growing body of research has demonstrated that alcohol abuse co-occurs with a broad range of mental health problems. To date, however, there is a scarcity of data concerning the co-occurrence of alcohol abuse and other problems in people who seek mental health outpatient services and, consequently, about gender differences among them. The present study surveyed 376 clients receiving outpatient services at a mental health center. Results demonstrate that women self-reported significantly more psychophysiological distress and family pathology and men reported more community problems and health concerns. Men drank significantly more than women, were more likely to have had a problem with alcohol over the past year, and were more likely to have been treated for substance abuse. For both men and women, the level of alcohol consumption varied directly with the severity of psychophysiological symptoms and community and health problems.

The current status of academic-mental health linkages in Rhode Island

The purpose of this study is to describe the current status of academic-public mental health linkages in the State of Rhode Island by querying key informants concerning their opinions in the following areas: clinical orientation and preferred clinical interventions, specific approaches to academic-mental health linkages, training and educational opportunities, obstacles to a career working with persons who have persistent and severe mental illness, and recommendations to improve academic-mental health linkages. Forty-eight of sixty key informants, among them academics, mental health administrators, clinical practitioners and consumer advocates, responded to the mailed survey. More than half the respondents rated affective disorders, schizophrenia and substance abuse to be their highest concern as professionals; most subscribed to biological models of mental illness as well as a variety of prevailing treatment strategies employed in the care of persons with severe mental illness; generally they rated the current status of academic-mental health linkages to be low, but recommended a range of remedies to improve and increase collaborative efforts.

Differences in Asian and white drinking: consumption level, drinking contexts, and expectancies

Despite the heterogeneous nature of interethnic drinking differences within racial groups, research has demonstrated that cautious generalizations can be made when comparing Asian and White drinking patterns. Persons in the United States who identify their race as "Asian" drink much less than their White counterparts, and they report fewer problems. Some have speculated that drinking patterns between racial groups are mediated by culturally influenced social learning. To date there has been very little research examining the expectancy of reinforcement from drinking between different racial, cultural or ethnic groups. The current study of 637 white and 179 Asian university students examined differences in alcohol consumption and problem levels, the social context of drinking, and alcohol expectancies. Results show considerable differences between Asian and White drinking and level of associated problems, as well as similarities and differences in social drinking contexts. It also appears that Asians expected greater tension reduction from drinking despite drinking less overall. Implications for further research are suggested that would link racial, and more specifically, ethnic drinking differences with culturally defined alcohol expectancies.

Increases in serum prolactin levels associated with syncopal attacks

Numerous investigators have found that serum prolactin levels increase after tonic-clonic and partial complex seizures, but the effect of syncope on prolactin levels has been studied little. Serum prolactin levels were measured following unexpected syncopal attacks in patients seeking emergency treatment in a community hospital. Levels sampled 18 to 60 minutes after syncopal episodes were increased in 8 of 11 cases. Follow-up prolactin levels, measured 17 to 222 days later, were normal in all eight cases in which they were initially increased. Most subjects had concurrent illness. Although the current study does not clarify whether it was the syncope, the concurrent illness, or both that caused the prolactin elevations, it implies that measurement of this hormone will not help the clinician in distinguishing between seizures and syncopal attacks.

Insulin receptor autophosphorylation occurs asymmetrically

The unoccupied insulin receptor is a structurally symmetric, disulfide-linked dimer, comprising two alpha beta halves, each with a potential insulin binding alpha subunit and a kinase active beta subunit. In the accompanying paper (Shoelson, S. E., Lee, J., Lynch, C. S., Backer, J. M., and Pilch, P. F. (1993) J. Biol. Chem. 268, 4085-4091), we described the utility of a novel insulin analogue, L-benzoylphenylalanineB25,B29 epsilon-biotin insulin (BBpa insulin)1 as a probe for receptor behavior, and we determined that binding and cross-linking of one BBpa insulin molecule could fully stimulate insulin receptor autophosphorylation. Here we use this analogue to determine the symmetry of the autophosphorylation reaction. The alpha beta half-receptor that does not covalently couple to BBpa insulin incorporates 50% more orthophosphate than the alpha beta half that becomes coupled to the insulin analogue. Phosphopeptide mapping of each receptor half shows minimal differences in the phosphorylation sites or their relative contribution to the phosphate content of each half. The kinetics of 32P incorporation into each receptor half are essentially identical over a 10-20-min time course. Phosphopeptide mapping analysis reveals that the phosphate incorporation patterns do not change between the two alpha beta half-receptor forms (BBpa insulin-linked and unlinked, respectively) at different time points or concentrations of ATP ranging from 12 to 200 microM. Based on these and other data, we propose a model of insulin receptor activation whereby binding of one insulin molecule can trigger autophosphorylation in an asymmetric fashion.

Alcohol consumption and presenting problems in an out-patient mental health clinic

Alcohol use has been shown to co-occur with a range of psychiatric disorders and psycho-social problems in both clinical and general population studies. The current survey of 683 out-patient mental health clients examined the relationship of self-reported alcohol use (as measured by the Quantity-Frequency index and the Retrospective Diary) with self-ratings of common mental health concerns. The South Shore Problem Inventory was developed as a brief self-report instrument to be used for routine assessment and research. The inventory yielded three factors after principal components analysis and Varimax rotation: affective/physiological signs and symptoms (Factor 1), interpersonal/family problems (Factor 2), and vocational/legal difficulties (including a self-rating of substance abuse) (Factor 3). MANOVA revealed that heavy drinking predicted significantly higher problem scores for all three factors. The SSPI showed good initial reliability and utility, and the three sub-scales were theoretically congruent with a social learning model of assessment. The use of similar problem scales and substance abuse indices can be used with a wider variety of both mental health and substance abuse treatment populations to provide routine self-report data for clinical and research applications.

Measuring alcohol consumption: a comparison of the retrospective diary and the quantity-frequency methods in a college drinking survey

As part of a larger study of college drinking, the quantity-frequency (Q-F) measure of alcohol consumption was compared to the retrospective diary (RD) method with 494 drinkers out of 606 respondents (75.8%) of 800 randomly selected undergraduates. Respondents were representative by sex and year in school of virtually all full-time undergraduates at Rutgers, the State University of New Jersey. The study tested the hypothesis that the RD would yield higher estimates of average alcohol consumption and of "heavy drinking" as defined by NIAAA typology (average two or more drinks per day) and of "peak drinking," a Q-F standard consisting of five or more drinks at least once per week. The study also compared the two methods as correlates of self-reported problems related to drinking. Results supported the major hypotheses that the RD would detect more overall consumption, heavy drinking and peak drinking than the Q-F. Results also demonstrated good consistency between the Q-F and RD as well as comparable correlations with the alcohol problem score.

Interfacial catalysis by phospholipase A2: evaluation of the interfacial rate constants by steady-state isotope effect studies

The kinetics of hydrolysis of phospholipid vesicles by phospholipase A2 (PLA2) in the scooting mode can be described by the Michaelis-Menten formalism for the action of the enzyme in the interface (E*). E* + S in equilibrium E*S in equilibrium E*P in equilibrium E* + Products The values of the interfacial rate constants cannot be obtained by classical methods because the concentration of the substrate within the lipid bilayer is not easily manipulated. In the present study, carbonyl-carbon heavy atom isotope effects for the hydrolysis of phospholipids have been measured in both vesicles and in mixed micelles in which the phospholipid was present in the nonionic detergent Triton X-100. A large [14C]carbonyl carbon isotope effect of 1.12 +/- 0.02 was measured for the cobra venom PLA2-catalyzed hydrolysis of dipalmitoylphosphatidylcholine in Triton X-100. In contrast, no isotope effect (1.01 +/- 0.01) was measured for the action of the porcine pancreatic and cobra venom enzymes on vesicles of dimyristoylphosphatidylmethanol in the scooting mode. In a second experiment, the hydrolysis of vesicles was carried out in oxygen-18 enriched water. Analysis of the released fatty acid product by mass spectrometry showed that it contained only a single oxygen-18. All of these results were used to estimate both the forward and reverse commitments to catalysis. The lack of doubly labeled fatty acid demonstrated that the product is released from the E*P complex faster than the reverse of the esterolysis step. The small isotope effect in vesicles demonstrated that the E*S complex goes on to products faster than substrate is released from the enzyme. The relevance of these results to an understanding of substrate specificity and inhibition of PLA2 is discussed. In addition, the conditions placed on the values of the rate constants obtained in the present study together with results obtained in the other studies described in this series of papers have led to the evaluation of most of the interfacial rate constants for the hydrolysis of phospholipid vesicles by PLA2.

Reliability of self-reports of alcohol use by community clients

Eighty-five of 116 randomly selected clients receiving case management services at a comprehensive community mental health center responded anonymously to a survey questionnaire that included two measures of self-reported alcohol use: questions about frequency and quantity and a retrospective diary for reporting the number of drinks consumed daily in the preceding week. Forty-two patients reported using alcohol; consumption was higher among younger patients. A significant correlation was found between responses to the frequency-quantity questions and the information provided in the retrospective diary, indicating that self-reports of alcohol consumption are reasonably reliable for the clients studied. Future research is needed to establish the reliability and validity of self-reported alcohol and drug use in typical treatment settings.

The endogenous functional turkey erythrocyte and rat liver insulin receptor is an alpha 2 beta 2 heterotetrameric complex

Previous studies have indicated that turkey erythrocyte and rat liver membranes contain endogenous alpha beta heterodimeric insulin receptors in addition to the disulphide-linked alpha 2 beta 2 heterotetrameric complexes characteristic of most cell types. We utilized 125I-insulin affinity cross-linking to examine the structural properties of insulin receptors from rat liver and turkey erythrocyte membranes prepared in the absence and presence of sulphydryl alkylating agents. Rat liver membranes prepared in the absence of sulphydryl alkylating agents displayed specific labelling of Mr 400,000 and 200,000 bands, corresponding to the alpha 2 beta 2 heterotetrameric and alpha beta heterodimeric insulin receptor complexes respectively. In contrast, affinity cross-linking of membranes prepared with iodoacetamide (IAN) or N-ethylmaleimide identified predominantly the alpha 2 beta 2 heterotetrameric insulin receptor complex. Similarly, affinity cross-linking and solubilization of intact turkey erythrocytes in the presence of IAN resulted in exclusive labelling of the alpha 2 beta 2 heterotetrameric insulin receptor complex, whereas in the absence of IAN both alpha 2 beta 2 and alpha beta species were observed. Turkey erythrocyte alpha 2 beta 2 heterotetrameric insulin receptors from IAN-protected membranes displayed a 3-4-fold stimulation of beta subunit autophosphorylation and substrate phosphorylation by insulin, equivalent to that observed in intact human placenta insulin receptors. Turkey erythrocyte alpha beta heterodimeric insulin receptors, prepared by defined pH/dithiothreitol treatment of IAN-protected membranes, were also fully competent in insulin-stimulated protein kinase activity compared with alpha beta heterodimeric human placenta receptors. In contrast, endogenous turkey erythrocyte alpha beta heterodimeric insulin receptors displayed basal protein kinase activity which was insulin-insensitive. These data indicate that native turkey erythrocyte and rat liver insulin receptors are structurally and functionally similar to alpha 2 beta 2 heterotetrameric human placenta insulin receptors. The alpha beta heterodimeric insulin receptors previously identified in these tissues most likely resulted from disulphide bond reduction and denaturation of the alpha 2 beta 2 holoreceptor complexes during membrane preparation.

Intrinsic kinase activity of the insulin receptor

Since the identification of the insulin receptor by insulin-binding activity almost two decades ago, our understanding of the structure and function of the insulin receptor has progressed tremendously. The importance of the intrinsic tyrosine protein kinase activity of the insulin receptor is implied by the fact that the insulin receptor belongs to a family of receptor tyrosine kinases which play a role in growth control, by experiments demonstrating the intimate association of normal kinase activity and insulin action, and by evidence that the intrinsic kinase activity can be regulated under certain conditions. There are still some major gaps in our knowledge concerning the structure/function of the insulin receptor such as how activation of the intrinsic kinase activity of the receptor leads to altered cellular physiology. The kinase may phosphorylate endogenous substrates or autophosphorylation may simply alter beta subunit conformation so it can then interact with an effector system (i.e. a serine kinase) directly, or indirectly through a G-protein. The truth may lie somewhere between these two pathways.

Intrinsic kinase activity of the insulin receptor. The intact (alpha 2 beta 2) insulin receptor from rat liver contains a kinase domain with greater intrinsic activity than the intact insulin receptor from human placenta

We are interested in developing methods to rigorously characterize the intrinsic enzymatic activity of the insulin receptor. We have previously shown that the intact, kinase active form of the receptor can be separated from inactive forms isolated from human placenta. Therefore, the determination of kinase activity, when normalized to the number of receptors based on binding, is not complicated by the presence of insulin receptor forms which bind insulin normally, but are kinase inactive. We now have extended this separation technique to insulin receptor preparations from rat liver. Thus, the determination and comparison of the intrinsic kinase activity of insulin receptor from human placenta and rat liver was performed. When normalized to the same number of insulin receptors which are autophosphorylated to the same degree, the rat liver insulin receptor catalyzes the transfer of phosphate from ATP to three different substrates, on average, 2.8-fold quicker than receptor from human placenta. This probably represents an inherent difference in the intrinsic kinase activity (Vmax), since the values for KM of the substrates are essentially identical, for insulin receptors from both sources. Intrinsic kinase differences may reflect different biological roles and/or differential regulation by exogenous factors. We are now examining this hypothesis in light of reports that demonstrate regulation of intrinsic kinase activity of the insulin receptor in certain physiological and pathological states.

Protein phosphotyrosine phosphatase purified from the particulate fraction of human placenta dephosphorylates insulin and growth-factor receptors

Protein phosphatase activity specific for Tyr(P) (phosphotyrosine) residues (PTP-phosphatase) was found in the cytosol and particulate fractions of human placenta. In the particulate fraction, half of the PTP-phosphatase activity could be extracted with 1% Triton X-100. The PTP-phosphatase remaining in the Triton-insoluble residue was solubilized with 0.6 M-KCl plus 1% CHAPS (3-[(3-cholamidopropyl)-dimethylammonio]propane-1-sulphonate) and was purified 1850-fold by adsorption to DEAE-Sepharose, affinity chromatography on Zn2+-iminodiacetate-agarose, phosphocellulose adsorption, Fractogel filtration and Mono Q chromatography. The cytoskeleton-associated PTP-phosphatase was distinguished from acid, alkaline and other protein Ser(P) (phosphoserine)/Thr(P) (phosphothreonine) phosphatases by its neutral pH optimum, activity in the presence of EDTA, inhibition by Zn2+, vanadate, or molybdate, and low activity with either [Ser(P)]phosphorylase a or p-nitrophenyl phosphate. The PTP-phosphate displayed a Km of 0.15 microM with [Tyr(P)]serum albumin as substrate, 10-100-fold lower than the Km for previously described protein phosphatases. The cytoskeleton-associated PTP-phosphatase catalysed the dephosphorylation of receptors for insulin, insulin-like growth factor-1 and epidermal growth factor labelled by autophosphorylation. The properties of this PTP-phosphatase suggest that it plays a role in the regulation of hormone receptors and cytoskeleton proteins by reversible phosphorylation on tyrosine residues.

Separation and characterization of three insulin receptor species that differ in subunit composition

Partially purified human placental insulin receptor preparations give rise to three distinct insulin-binding peaks when eluted from a Mono Q high-performance liquid chromatography anion-exchange column. We analyzed the basis for this phenomenon by affinity cross-linking of insulin to each peak, followed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. We find that the three insulin-binding peaks represent different molecular weight complexes with the following subunit composition: (alpha beta)2, (alpha beta)(alpha beta'), and (alpha beta')2, where beta' represents a proteolytically derived fragment of the beta subunit. This analysis of subunit composition was confirmed by silver staining of affinity-purified insulin receptor following resolution of the forms on a Mono Q column as described previously. We have characterized the three isolated insulin receptor forms with regard to ligand binding by LIGAND and Scatchard analysis. We also measured insulin-stimulatable autophosphorylation and exogenous kinase activity directed toward poly(Glu/Tyr) (4:1). The three forms of the insulin receptor exhibit similar KD's for insulin binding to the high- and low-affinity sites. The (alpha beta)2 and (alpha beta)(alpha beta') forms of the insulin receptor display superimposable curvilinear Scatchard plots. In contrast, only the intact holoreceptor (alpha beta)2 form demonstrates insulin-stimulatable autophosphorylation and exogenous kinase activity. The (alpha beta)(alpha beta') form has reduced basal kinase activity which was not increased by prior incubation with insulin. The (alpha beta')2 form lacks a kinase domain and consequently demonstrated no kinase activity.(ABSTRACT TRUNCATED AT 250 WORDS)

The ligand binding subunit of the insulin-like growth factor 1 receptor has properties of a peripheral membrane protein

125I-insulin-like growth factor 1 was cross-linked to its receptor in human placenta microsomal membranes. The microsomes were treated with urea, with dithiothreitol or with both reagents prior to centrifugation at 100,000 X g. We found that greater than 80% of the label was membrane-associated following separate treatment with urea or dithiothreitol, but greater than 80% of the radioactivity remained in the supernatant after simultaneous exposure to both reagents. In identical experiments employing 125I-epidermal growth factor, no condition led to the release of greater than 10% of label from the membrane. We conclude that the ligand binding subunit of the insulin-like growth factor 1 receptor, like peripheral membrane proteins, lacks a membrane anchoring domain.

Analyzing the hospice market

Hospitals should base decisions about hospice services on need rather than on subjective feelings. Marketing methods can be used to identify the potential population for hospice care.