The influence of initial spinal cord haematoma and cord compression on neurological grade improvement in acute traumatic spinal cord injury: A prospective observational study

STUDY DESIGN

Prospective observational cohort study linked with administrative data.

OBJECTIVES

Magnetic Resonance Imaging (MRI) is routinely performed after traumatic spinal cord injury (TSCI), facilitating early, accurate diagnosis to optimize clinical management. Prognosis from early MRI post-injury remains unclear, yet if available could guide early intervention. The aim of this study was to determine the association of spinal cord intramedullary haematoma and/or extent of cord compression evident on initial spine MRI with neurological grade change after TSCI.

METHODS

Individuals with acute TSCI ≥16 years of age; MRI review. Neurological gradings (American Spinal Injury Association Impairment Scale (AIS)) were compared with initial MRI findings. Various MRI parameters were evaluated for prediction of neurological improvement pre-discharge.

RESULTS

120 subjects; 79% male, mean (SD) age 51.0 (17.7) years. Motor vehicle crashes (42.5%) and falls (40.0%) were the most common injury mechanisms. Intramedullary spinal cord haematoma was identified by MRI in 40.0% of patients and was associated with more severe neurologic injury (58.3% initially AIS A). Generalised linear regression showed higher maximum spinal cord compression (MSCC) was associated with lower likelihood of neurological improvement from initial assessment to follow up prior to rehabilitation discharge. Combined thoracic level injury, intramedullary haematoma, and MSCC > 25% resulted in almost 90% probability of pre-discharge AIS (grade A) remaining unchanged from admission assessment.

CONCLUSIONS

MRI is a vital tool for evaluating the severity and extent of TSCI, assisting in appropriate management decision-making early in TSCI patient care. This study adds to the body of knowledge assisting clinicians in prognostication.

Oral vaccination of dogs with a monovalent live-avirulent vaccine confers 1 year of immunity against Bordetella bronchiseptica challenge

This experimental challenge study assessed immune protection 1 year after a single dose of live-attenuated oral Bordetella bronchiseptica (Bb) vaccine in dogs. Forty Bb-seronegative 7-9-week-old puppies were randomly assigned at Day 0 to receive a single oral dose of either Bb vaccine (n = 20; vaccinated group) or sterile water (n = 20; control group). Groups were housed separately until comingling 1 day pre-challenge (Day 365). Challenge with virulent aerosolized Bb occurred at Day 366. Clinical scores were obtained at Days 1-7, and 366-380. Bb microagglutination test (MAT) titers were obtained at Days -7, 0, monthly post-vaccination, and Days 358, 365, and 380. Nasal swabs were collected for microbiological assessment at Days -7, 0, 365, and 367-380. Oral Bb vaccination was not associated with side effects. Pre-challenge, vaccinated dogs developed persistent Bb MAT titers and control dogs remained seronegative. Post-challenge, duration of cough was longer in control dogs (least square means [LSM], 8.6 days) than vaccinated dogs (LSM, 1.5 days; P < 0.0001), with more control dogs having cough on 2 or more consecutive days (control group, n = 17/19, 89.5%; vaccinated group, n = 3/19, 15.8%; P = 0.0011). Post-challenge, Bb shedding occurred in all control dogs and 5/19 (26%) vaccinated dogs. Average duration of Bb shedding was longer in the control group (11.9 days vs. 0.6 days; P < 0.0001) and nasal Bb loads were higher in the control group (P < 0.00001). Orally administered Bb vaccine stimulated immunity that was still protective against virulent Bb challenge after 1 year.

Tantalum trabecular metal implants in anterior cervical corpectomy and fusion: 2-year prospective analysis

Anterior cervical decompression for two or more cervical spondylotic levels can be performed using either multiple anterior cervical discectomies and fusion or anterior cervical corpectomy and fusion (ACCF). A variety of options for ACCF implants exist but to our knowledge, there is no clinical data for the use of tantalum trabecular metal implants (TTMI) for ACCF. A retrospective review was performed of prospectively collected data for ten patients undergoing ACCF with TTMI between 2011 and 2012. Radiological outcome was assessed by measuring the change in cervical (C) lordosis (fusion Cobb and C2-C7 Cobb), graft subsidence (anterior/posterior, determined by the subsidence of anterior/posterior body height of fused segments; cranial/caudal, determined by the cranial/caudal plate-to-disc distances) and rate of fusion using lateral cervical X-rays of patients at 0, 6, 12 and 24months post-operatively. The Neck Disability Index (NDI) assessed clinical outcome pre-operatively and at 6, 12 and 24months post-operatively. Cervical lordosis (Cobb angle of fused segment) was 5.2° (± 4.2°) at 0months and 6.0° (± 5.7°) at 24months post-operatively. Graft subsidence was observed to occur at 6months post-operatively and continued throughout follow-up. Anterior, posterior and caudal subsidence occurred more in the first 12months post-operatively than in the following 12months (p<0.05). Average pre-operative NDI was 45%. Average NDIs were 18%, 13% and 10% at 6, 12 and 24months post-operatively, respectively. ACCF patients treated with TTMI demonstrated stable cervical lordosis over 2years of follow-up and 100% fusion rates after 2years. Measures of subsidence appeared to decrease with time. Patients experienced improved clinical outcomes over the 2-year period.

HYSTEROSALPINGOGRAPHY AND LAPAROSCOPY IN EVALUATING FALLOPIAN TUBES IN THE MANAGEMENT OF INFERTILITY IN COTONOU, BENIN REPUBLIC

INTRODUCTION

Hysterosalpingography, along with laparoscoy, are the most requested examinations for tubal factor exploration for infertility, in developing countries.

OBJECTIVE

To compare the results of hysperosalpingography and laparoscopy in patients assessed for infertility.

PATIENTS & METHODS

This was a 5 years retrospective, descriptive study done at the Obstetrics and Gynecology Clinic of the HKM Centre, National University Hospital. All the patients admitted for infertility of tubal origin were included. These included 96 patients who had undergone hysterosalpingography followed by laparoscopy. The analysis was done with the SPSS version 12.0.1.

RESULT

The mean age of the patients was 33.3 years. Infertility was primary in 66.3% of cases and secondary in 33.7% of cases and the average duration was 48.9 months. Hysterosalpingography diagnosed 9.37% of proximal tubal obstruction while laparoscopy diagnosed same in 17.71%. Besides pelvic adhesive bands seen in 33.33% of cases, laparoscopy was able to visualize patent tubes with some pathology in 11.46%, and pelvic endometriosis in 6.25% of cases.

CONCLUSION

The results of HSG and those of laparoscopy are complementary in tubal infertility evaluation. While HSG seems to be reliable when the tubes are patent, laparoscopy helps to reveal false tubal obstructions observed with HSG, and also helps in the diagnosis of pelvic adhesive bands and endometriosis.

The effects of an obesogenic diet during pregnancy on fetal growth and placental gene expression are gestation dependent

Exposure to overnutrition in utero may increase offspring cardiometabolic disease risk. A mouse model of maternal exposure to an obesogenic diet (DIO) was used to determine effects on fetal and placental weight and gene expression in mid- and late gestation. DIO altered placental gene expression in mid-gestation without differences in fetal or placental weights. Weight gain was attenuated in DIO dams in late gestation and male pup weight was reduced, however there were no persistent changes in placental gene expression. Differences in maternal weight gain and/or specific dietary components may impact on fetal and placental growth and later disease risk.

Vaccination of dogs with Duramune DAPPi+LC protects against pathogenic canine parvovirus type 2c challenge

In this study, we determined whether vaccination with Duramune DAPPi+LC containing canine parvovirus (CPV) type 2b protects against challenge with virulent CPV antigenic type 2c. Seven healthy dogs, seronegative for CPV2, were enrolled into two treatment groups; five were vaccinated twice, 21 days apart, with minimum titre vaccine, and two were given saline. Dogs were challenged with CPV 2c three weeks later. Clinical observations, body weight and rectal temperature measurements, blood samples for serology and white blood cell counts and faecal samples for virus excretion were collected. Control dogs remained seronegative until challenge; vaccinated dogs seroconverted and were positive for antibodies to CPV2 from day 21. Four days after challenge, clinical signs associated with parvovirus infection (vomiting, paroxysmal shivering, depression, loose stools) were observed in the control dogs. Both animals were withdrawn from the study for welfare reasons one day later. On day 47, leucopenia was observed in controls, with white blood cell counts less than 50 per cent prechallenge values. No specific clinical sign of parvovirus infection were observed in the vaccinated dogs, nor was (detectable) challenge virus shed in faeces suggesting that antibodies generated contributed sterilising immunity. We conclude that vaccination of dogs with Duramune DAPPi+LC protects against challenge with a virulent field strain of CPV 2c.

Immunocastration of Bos indicus x Brown Swiss bulls in feedlot with gonadotropin-releasing hormone vaccine Bopriva provides improved performance and meat quality

The objective of this study was to determine the effects of a GnRH vaccine on feedlot performance and meat quality in Bos indicus Zebu × Brown Swiss bulls. The study was a 2 × 2 factorial arrangement of treatments with 1,600 bulls allocated by BW into 4 groups of ≈ 400 animals. The GnRH vaccine (Bopriva) was injected on d 0 and 42, and anabolic implants given on d 0 (Component E-S) and d 84 (Synovex Choice). Group designations were: Con = placebo control; Imp = implants alone; Vac = GnRH vaccine alone; and Vac+Imp = GnRH vaccine together with implants. The second GnRH vaccination at d 42 resulted in elevated titers of IgG antibody and suppressed concentrations of testosterone in vaccinated groups (Vac and Vac+Imp) at d 56 (P < 0.001), with titers and suppressed testosterone persisting to d 147 (P < 0.001). Groups Vac and Vac+Imp had reduced testes weights at slaughter on d 147 (P < 0.001). Bulls in group Vac were not different in final BW, HCW, or ADG (d 42 to 147) relative to bulls in group Con. Bulls in group Vac+Imp had greater final BW than bulls in group Imp (P = 0.008) and greater BW than bulls in group Vac and group Con (P < 0.001). The HCW of Vac+Imp bulls was greater than the Vac or Con bulls (P < 0.001) but was not different to the Imp bulls (P = 0.294). Improved ADG was obtained by vaccination with the GnRH vaccine, in the presence of implants (group Vac+Imp compared with group Imp, P < 0.001) or absence of implants (group Vac compared with group Con, P = 0.028). Meat quality of bulls receiving the GnRH vaccine was improved irrespective of implant status, with a 1.6- to 2.6-fold increase in the proportion of bulls in groups Vac and Vac+Imp, respectively, grading as USDA Choice (P < 0.002) and with greater fat depth at the 12th rib (P < 0.001). Meat tenderness was improved in the vaccine groups (Vac and Vac+Imp) compared with groups Con and Imp (P < 0.004). Use of the GnRH vaccine Bopriva in Bos indicus × Brown Swiss bulls finishing in a feedlot under Mexican husbandry conditions can provide improved performance in combination with implants (increased BW and ADG) and improved meat quality, with or without implants, and in particular, better USDA carcass grading and loin fat cover.

P2-08-01: Impact of Aromatase Inhibitors on Background Parenchymal Enhancement and Amount of Fibroglandular Tissue on Breast MRI

Background: On breast MRI, background parenchymal enhancement (BPE) and volume of fibroglandular tissue (FGT) have been shown to reflect a patient's hormonal status. Tamoxifen has been shown to reduce mammographic breast density and may serve as an early predictor of response in the prevention setting (Cuzick, JNCI 2011). We have shown that adjuvant tamoxifen can reduce BPE in the unaffected breast in women with breast cancer. We hypothesize that aromatase inhibitor (AI) induced endocrine changes in breast tissue should also be evident and therefore we performed a study to evaluate whether adjuvant AI therapy influences BPE or amount of FGT in the contralateral breast.

Methods: An electronic medical record review identified 856 postmenopausal women with stage I-III breast cancer who had at least two breast MRIs and took adjuvant AI treatment. A retrospective chart review was conducted to select those patients without a history of prior tamoxifen or raloxifene treatment who had a MRI of the contralateral breast both before and during 6 to 12 months of AI treatment. After exclusion of all irradiated breasts, 168 women were eligible. MRIs were performed between August 1999 and June 2010. Two radiologists who were blind to AI treatment status, independently rated level of BPE and amount of FGT using categorical scales: BPE — Minimal, Mild, Moderate, Marked; FGT — Fatty, Scattered, Heterogeneously Dense, Dense (based on proposed BIRADS criteria for BPE and on ACR criteria for FGT). Blinded side-by-side direct comparison evaluated whether there was a category change between the two MRIs. A consensus was reached in cases of disagreement. The Wilcoxon signed-rank test was used to assess changes in rating categories for BPE and FGT between before and during AI breast MRIs. A waiver of authorization was granted by the institutional review board for this study.

Results: In this study 127/168 (76%) women were treated with anastrozole, 33/168 (20%) with letrozole and 8/168 (5%) with exemestane. Based on the blinded side-by-side comparison, a category (or more) decrease in BPE occurred during treatment with AIs (p&lt;0.0001). There was an overall shift from higher to lower degree of BPE in 35% (45/127) of the women taking anastrozole while a category increase occurred in only one woman (1%; p &lt;0.0001). A similar result was seen in the women taking letrozole [45% (15/33) had a decrease versus 3% (1/33) an increase; p=0.0003] and exemestane [25% (2/8) had a decrease versus 12.5% (1/8) an increase; p=0.50]. For FGT a category decrease occurred in 5% (6/127) of anastrozole users while no increase occurred [0% (0/127), p=0.016]. The respective numbers for letrozole were 3% (1/33) and 0% (0/33), and nobody on exemestane had a change in FGT.

Conclusions: After 6 to 12 months of treatment with adjuvant AIs, there was a statistically significant category (or more) decrease in BPE. BPE is more sensitive than FGT to changes in normal breast stroma that occur during adjuvant treatment with AIs and BPE may be a marker of anti-hormonal activity in the breasts.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-01.

Evolution of the male-determining gene SRY within the cat family Felidae

In most placental mammals, SRY is a single-copy gene located on the Y chromosome and is the trigger for male sex determination during embryonic development. Here, we present comparative genomic analyses of SRY (705 bp) along with the adjacent noncoding 5' flank (997 bp) and 3' flank (948 bp) in 36 species of the cat family Felidae. Phylogenetic analyses indicate that the noncoding genomic flanks and SRY closely track species divergence. However, several inconsistencies are observed in SRY. Overall, the gene exhibits purifying selection to maintain function (omega = 0.815) yet SRY is under positive selection in two of the eight felid lineages. SRY has low numbers of nucleotide substitutions, yet most encode amino acid changes between species, and four different species have significantly altered SRY due to insertion/deletions. Moreover, fixation of nonsynonymous substitutions between sister taxa is not consistent and may occur rapidly, as in the case of domestic cat, or not at all over long periods of time, as observed within the Panthera lineage. The former resembles positive selection during speciation, and the latter purifying selection to maintain function. Thus, SRY evolution in cats likely reflects the different phylogeographic histories, selection pressures, and patterns of speciation in modern felids.

Prevalence of polycystic ovaries in women with self-reported symptoms of oligomenorrhoea and/or hirsutism: Northern Finland Birth Cohort 1966 Study

BACKGROUND

The aim of this study was to investigate the prevalence of polycystic ovaries (PCO) among women with self-reported oligomenorrhoea and/or hirsutism and to see whether women with symptoms and PCO have less favourable levels of biochemical markers than controls or women with symptoms and normal ovaries.

METHODS

The ultrasonographic ovarian morphology and the hormonal and metabolic profile of female cases with self-reported symptoms typical of polycystic ovary syndrome (PCOS) (n = 196) and asymptomatic controls (n = 67) at the age of 31 years were examined in a general population-based Northern Finland Birth Cohort 1966.

RESULTS

The prevalence of PCO (37.3 versus 18.2%; P = 0.004) was significantly higher in the cases (oligomenorrhoea and/or hirsutism) than in the controls. PCO morphology was detected in 18.4% of those who reported only hirsutism, in 47.9% of those reporting only oligomenorrhoea, and in 70.4% of those reporting both symptoms. In the cases with PCO compared to (i) the controls and (ii) the cases without PCO, body mass index (P = 0.026 and P = 0.011), ovarian volume [right P = 0.001, left P = 0.208 (non-significant) and right P < 0.001, left P = 0.022], mean follicle number (P < 0.001 and P < 0.001), testosterone (P = 0.063 and P = 0.029), free androgen index (P = 0.007 and P = 0.013) and insulin (P = 0.033 and P = 0.040) were higher, and sex hormone-binding globulin (P = 0.039 and P = 0.068) and glucose:insulin ratio (P = 0.060 and P = 0.054) lower. Cases with PCO also had higher waist:hip ratio (P = 0.011), infertility rate (P = 0.005) and glucose (P = 0.045) and lower insulin-like growth factor-binding protein-1 (P = 0.012) than controls. The clinical, hormonal and metabolic characteristics did not differ significantly between cases without PCO and controls with the exception of infertility rate, which was significantly higher in the cases without PCO (26.4 vs. 10.0%; P = 0.009).

CONCLUSIONS

In a general population, women with symptoms of oligomenorrhoea and/or hirsutism more often have PCO than asymptomatic women. Levels of biochemical and clinical markers in symptomatic women with PCO differed from and were less favourable than those in symptomatic women without PCO or asymptomatic women, implying an increased risk for health.

Optimization of the anti-(human CD3) immunotoxin DT389-scFv(UCHT1) N-terminal sequence to yield a homogeneous protein

The production and regulatory approval processes for biopharmaceuticals require detailed characterization of potential products. Therapeutic proteins should preferably be homogeneous, although limited, reproducible, heterogeneity may be tolerated. A diphtheria toxin-based anti-(human CD3) immunotoxin, DT389-scFv(UCHT1), was expressed in Escherichia coli and purified following refolding [DT389 corresponds to amino acids 1-389 of diphtheria toxin, scFv is single-chain variable-region antibody fragment and UCHT1is an anti-(human CD3) monoclonal antibody]. Biochemical characterization of this molecule by MS and N-terminal sequencing by Edman degradation revealed that the protein was heterogeneous at the N-terminus, containing species both with (60%) and without (40%) the initiator methionine residue. In an attempt to generate an N-terminally homogeneous molecule, a panel of seven N-terminal variants was designed, based on the published specificity of bacterial methionine aminopeptidase. Following bacterial expression, partial purification and separation on SDS/PAGE, these proteins were subjected to N-terminal sequencing by Edman degradation. Three of the mutants yielded a 100% homogeneous amino acid sequence. By contrast, the original DT389-scFv(UCHT1) protein and four variant proteins yielded two sequences with varying ratios corresponding to species with and without methionine. The N-terminal sequences of the three homogeneous clones were MLADD and MLDD, where the methionine was completely retained, and SADD, where the methionine was completely removed. One of the homogeneous mutants (SADD) was expressed, refolded and purified and found to be equipotent with the parent immunotoxin. Thus, using a rational mutagenesis approach, three N-terminally homogeneous variants of DT389-scFv(UCHT1) have been identified, at least one of which is functionally indistinguishable from the parent immunotoxin. This approach is generally applicable to biopharmaceutical production and immunotoxin development in particular.

Nuclear magnetic resonance study of doxorubicin binding to cardiolipin containing magnetically oriented phospholipid bilayers

Doxorubicin (DOX) is a potent anthracycline cancer drug whose interaction with anionic membrane phospholipids, such as cardiolipin (CL), is thought to contribute to its cytotoxicity as well as induce cardiotoxic side effects. We have studied the interaction of DOX with a CL containing model membrane system using high resolution, oriented sample (31)P and (2)H NMR. The model membrane system is composed of a bilayer forming phospholipid and a detergent that breaks the extended bilayers into disc-shaped micelles (bicelles) that can orient in a magnetic field. The effects of DOX on the phospholipid bilayer were monitored using samples containing dimyristoylphosphatidylcholine (DMPC), selectively deuterated in either headgroup or acyl chain positions, and measuring the changes in (2)H quadrupolar splittings as DOX was added. Changes in quadrupolar splittings upon DOX addition provide evidence for interaction with both surface and buried sites within the membrane bilayer.

Influence of relative binding affinity on efficacy in a panel of anti-CD3 scFv immunotoxins

The in vitro cell killing potency of an immunotoxin reflects the aggregate of several independent biochemical properties. These include antigen binding affinity; internalization rate, intracellular processing and intrinsic toxin domain potency. This study examines the influence of antigen binding affinity on potency in various immunotoxin fusion proteins where target antigen binding is mediated by single chain antibody variable region fragments (scFv). Firstly, the relationship between affinity and potency was examined in a panel of four scFv immunotoxins generated from different anti-CD3 monoclonal antibodies fused to the 38 kDa fragment of Pseudomonas aeruginosa exotoxin A (PE38). Of these four scFv-PE38 immunotoxins, the one derived from the anti-CD3 monoclonal antibody UCHT1 has highest cell killing potency. Analysis of these four scFv-PE38 immunotoxins indicated a correlation between antigen binding affinity and immunotoxin potency in the cell killing assay with the exception of the scFvPE38 immunotoxin derived from the antibody BC3. However this scFv appeared to suffer a greater drop in affinity ( approximately 100x), relative to the parent Mab than did the other three scFvs used in this study (2-10x). Secondly, the scFv(UCHT1)-PE38 immunotoxin was then compared with a further panel of scFv(UCHT1)-derived immunotoxins including a divalent PE38 version and both monovalent and divalent Corynebacterium diphtheriae toxin (DT389) fusion proteins. When the scFv-UCHT1 domain was amino-terminally positioned relative to the toxin, as in the scFv(UCHT1)-PE38, an approximately 10-fold higher antigen-binding affinity was observed than with the C-terminal fusion, used in the DT389-scFv(UCHT1) molecule. Despite this lower antigen-binding activity, the DT389-scFv immunotoxin had a 60-fold higher potency in the T-cell-killing assay. Thirdly, a divalent form of the DT389-scFv construct, containing tandem scFv domains, had a 10-fold higher binding activity, which was exactly reflected in a 10-fold increase in potency. Therefore, when comparing immunotoxins in which scFvs from different antibodies are fused to the same toxin domain (DT or PE) a broad correlation appears to exist between binding affinity and immunotoxin potency. However, no correlation between affinity and potency appears to exist when different toxin domains are combined with the same scFv antibody domain.

Investigation of the comparative toxicity of 5-FU bolus versus 5-FU continuous infusion circadian chemotherapy with concurrent radiation therapy in locally advanced rectal cancer

PURPOSE

To compare the relative toxicities of bolus versus infusional 5-FU chemotherapy administrated concurrently during external beam irradiation in patients with locally advanced rectal cancer following surgical extirpation.

METHODS

A total of 26 eligible patients were retrospectively identified as having been treated for rectal adenocarcinoma at the Stratton VAMC between 1989 and 1997. A comparative analysis of treatment dose intensities, treatment delays and toxicities in these patients was performed.

RESULTS

Significantly less WBC toxicity was observed in the patients receiving infusional 5-FU chemotherapy. The other toxicities, with the exception of skin toxicity, were generally less frequent in the 5-FU infusional group. When the toxicities were corrected for 5-FU dose intensity, to yield toxicity per mg of 5-FU, statistically significant differences were found for hematological toxicity (WBC and platelets), and for gastrointestinal toxicity (frequency and severity of diarrhea and weight loss). The majority of patients receiving infusional 5-FU therapy were treated using a circadian pattern of treatment peaking around the time of the radiation therapy. Patients receiving infusional 5-FU were able to tolerate over twice the dose intensity as those receiving bolus administration. Local recurrence rate in all patients was 3.8% comparing favorably to other reported studies. Distant recurrence frequency was also acceptable at 34.6% for the group.

CONCLUSION

Infusional 5-FU chemotherapy compared with bolus therapy during pelvic radiation minimizes toxicity to the patient while maximizing the dose of 5-FU that can be delivered. As infusional 5-FU therapy during radiation has previously been shown to increase disease free duration and survival, infusional 5-FU should be considered as an acceptable standard of care to prevent local recurrence of rectal adenocarcinoma following its resection. Shaping this infusional 5-FU chemotherapy within the day so that most of the daily dose is delivered around the time of the radiation therapy may further modify the toxic therapeutic ratio of combined modality therapy.

Pegylation of magnetically oriented lipid bilayers

We report NMR data for magnetically oriented phospholipid bilayers which have been doped with a lipid derivatized with a polyethylene glycol polymer headgroup to stabilize samples against aggregation. (13)C, (31)P, and (2)H NMR data indicate that the incorporation of PEG2000-PE (1% molar to DMPC) does not interfere with the orientation properties of bicelles prepared at 25% w/v with or without the presence of lanthanide. Bicelles prepared at 10% w/v are also shown to orient when PEG2000-PE is added. The addition of PEG2000-PE to cholesterol-containing, lanthanide-flipped bicelles is shown to inhibit sample phase separation and improve spectral quality. Furthermore, the addition of PEG2000-PE to high w/v bicelles (40% w/v) is demonstrated to lead to an increase in overall sample order.

Are religious grandparents more involved grandparents?

OBJECTIVES

This study explores how various aspects of a grandparent's religiousness are related to involvement with their grandchildren.

METHODS

The study ascertains whether religious grandparents are significantly more involved with their grandchildren than less religious grandparents by testing a series of bivariate and multivariate regression models. Multiple measures both of religiousness and of grandparent involvement are used. The study also examines factors that potentially confound, link, or explain the connection between religious involvement and grandparenting (e.g., demographic factors, health, community involvement, traditional values, ties to others). The sample of 585 grandparents comes from two related studies of rural families, the Iowa Youth and Families Project and the Iowa Single Parent Project.

RESULTS

Overall, the results indicate that religious grandparents are more involved grandparents, and this involvement is explained in part by their generally greater involvement in all types of family and social ties--religious grandparents are more likely to be enmeshed in social ties to others.

DISCUSSION

The implications of these findings are discussed in light of prior research that finds little influence of religion. We also consider the implications of our results for the future of grandparent involvement.

Sequence requirements for upregulated expression of Drosophila hsp70 transgenes during aging

hsp70 protein and hsp70:lacZ fusion reporters are upregulated during aging and in response to oxidative stress in the thorax of Drosophila. hsp70 expression was increased during aging in each of seven different Drosophila genetic backgrounds tested, 2.6-4.8-fold. DNA sequence requirements were investigated by analysis of nine distinct hsp70:lacZ fusion reporter constructs in multiple independent transgenic lines. hsp70 sequences -194 to +276 supported an average 2.7-fold increase during aging. This increase was reduced or eliminated by deletion or point mutation of the heat shock response elements, consistent with a transcriptional mechanism. Similar sequence requirements were observed for increased expression in response to catalase null mutation as a model of oxidative stress. hsp70 5'UTR sequences were required for efficient basal expression of transgenes, but were not sufficient to confer detectable upregulation during aging. Inclusion of additional hsp70 coding region sequences from +276 to + 1011 created a larger hsp70:lacZ fusion protein and had two effects: dramatic reduction of the overall expression level of the fusion protein, and an additional three to fourfold upregulation during aging. These results suggest that the coding region sequences reduce fusion protein abundance and that this negative effect decreases as a function of age. The data support a model for increased expression of hsp70 transgenes during aging involving both transcriptional and posttranscriptional components.

A study of infectious intestinal disease in England: microbiological findings in cases and controls

A study was undertaken to identify the microorganisms and toxins in stool specimens associated with infectious intestinal disease (IID) among cases in the community and presenting to general practitioners (GPs) and in asymptomatic controls. Population based cohorts were recruited from practice lists in 70 practices and followed for 26 weeks (cohort component). Seven hundred and sixty-one cases of IID identified from the cohorts, 2893 cases who presented to GPs in 34 of the practices (GP component), and age/sex matched control subjects (555 and 2264, respectively) submitted stool specimens by post for comprehensive microbiological examination. Campylobacter spp (12.2% of stools tested), rotavirus group A (7.7%), and small round structured virus (SRSV) (6.5%) were the organisms most commonly detected in the GP component. SRSV was identified in 7.0% of cases in the community cohort. No target microorganisms or toxins were identified in 45.1% and 63.1% of cases in the two components. Aeromonas spp, Yersinia spp, and some enterovirulent groups of Escherichia coli were detected as frequently in controls as in cases. The higher frequency of detection of campylobacter, salmonella, and rotavirus among cases who presented to GPs than among those in the community suggests that those pathogens cause more severe illness. No enteropathogens were detected from a large proportion of cases although comprehensive standard methods were used to seek them.

Aging-specific expression of Drosophila hsp22

hsp22 is among the least abundantly expressed Drosophila heat shock (hs) genes during both development and heat stress. In contrast, hsp22 was found to be the most abundantly expressed hs gene during Drosophila aging. During aging, hsp22 RNA was induced 60-fold in the head, with somewhat lower level induction in abdomen and thorax. Induction of the other hs gene RNAs was </=3-fold, except for hsp23, which was induced approximately 5-fold in thorax. hsp22 protein was detected using rat anti-hsp22 polyclonal antisera and was induced >150-fold, with particularly abundant expression in eye tissue. Aging-specific induction of hsp22 was reproduced by hsp22:lacZ fusion reporter constructs in transgenic flies. Analysis of specific promoter mutations in transgenic flies indicated that functional heat shock response elements are required for hsp22 induction during aging. Finally, comparison of hsp22 RNA and protein expression patterns suggests that aging-specific expression of hsp22 is regulated at both the transcriptional and the posttranscriptional levels. Aging-specific induction of hsp22 is discussed with regard to current evolutionary theories of aging.

Nursing clients of Greek ethnicity at home

The home healthcare nurse who cares for persons with Greek ancestry should be aware of their unique cultural heritage. The nurse should also be aware that Greek people throughout the world are proud and independent, valuing their religious faith and practices, good health, education, and success. Care should be designed to include appreciation of traditions and customs that these clients may have. The nurse should make a special effort to develop trust with the Greek client and family members in order to effectively implement culturally competent healthcare.

Perceived self-efficacy and grandparenting

OBJECTIVES

This study identifies grandparents who feel efficacious in their role and the consequences of such beliefs for actual involvement with an adolescent grandchild.

METHODS

The sample of 883 grandparents comes from two related studies of rural families, the Iowa Youth and Families Project and the Iowa Single Parent Project. Our research questions are answered by testing a series of bivariate and multivariate regression models.

RESULTS

Results show much variability in perceptions of being able to influence one's grandchild. Church attendance, knowledge of one's own grandparents, a farm history, a strong grandparent-parent bond, proximity, and having fewer grandchildren emerged as significant predictors of grandparents' perceptions of efficacy. Grandparents with strong self-efficacious beliefs play an active role in the lives of their grandchildren.

DISCUSSION

With an increasing number of grandparents taking responsibilities for their grandchildren, a greater understanding of the experiences and resources that enhance their sense of personal efficacy in this role warrants priority in generational studies.

Cold exposure regulates the renin-angiotensin system

The effect of cold exposure on the systemic renin-angiotensin system and on regulation of the angiotensin II (Ang II) receptor was examined in target organs for Ang II with cardiovascular relevance (left ventricle, kidney, lung) and metabolic relevance [interscapular brown adipose tissue (ISBAT), liver] to the functional consequences of cold exposure. In time course studies, the effects were examined of 4 hr or 1, 3 and 7 days of exposure to cold (4 degrees C) on plasma Ang II concentration and Ang II receptor binding characteristics in rat liver. Plasma Ang II concentration increased 10-fold after 4 hr of cold exposure, returned to control levels at days 1 and 3 of cold exposure, and was again increased (2-fold) at 7 days of cold exposure. The affinity of [125I]Sar1, Ile8-Ang II binding in membranes prepared from rat liver was not altered in cold-exposed rats. The density (Bmax) of binding sites in liver from cold-exposed rats was increased by day 1 and remained elevated over time-matched controls. Alterations in Ang II receptor density did not parallel plasma Ang II concentration in their time course, suggesting that cold-induced regulation of the Ang II receptor was not substrate mediated. In rats from the 7-day time point of cold exposure, Ang II receptor binding characteristics were examined in ISBAT and lung. Increases in Ang II receptor density were evident in ISBAT but not lung. To determine whether cold-induced increases in food intake contributed to elevations in plasma Ang II concentration and/or Ang II receptor density, a group of cold-exposed rats (7 days) were pair-fed to food intake levels of control rats. Pair-feeding of cold-exposed rats eliminated increases in plasma Ang II and norepinephrine concentration but did not prevent increases in Ang II receptor density in liver, ISBAT, kidney and left ventricle. Moreover, increases in Ang II receptor density were augmented in kidney and left ventricle from cold-exposed rats that were pair-fed. Results from these studies demonstrate that cold exposure resulted in an increase in plasma Ang II concentration through mechanisms related to increased food intake. Elevations in food intake in cold-exposed rats contributed to tissue-specific increases in Ang II receptor density. Moreover, cold-induced increases in Ang II receptor density were not related to plasma Ang II concentration.

Drug abuse treatment success among needle exchange participants

OBJECTIVE

Although lowering incidence rates of human immunodeficiency virus (HIV) transmission is the primary goal of needle exchange programs (NEPs), other desirable outcomes are possible. Referring exchange participants to more comprehensive drug abuse treatment programs has the potential to reduce or eliminate the use of drugs. This possibility was evaluated by comparing the treatment responses of new admissions with an outpatient opioid agonist treatment program in Baltimore, Maryland.

METHODS

New admissions (1994 - 1997) to an opioid agonist treatment program were first grouped by referral source (needle exchange, n = 82 vs. standard referrals, n = 243) and then compared on admission demographic and clinical variables and response to treatment during the first three months. Outcome measures included retention rates, self-reported drug use and injecting frequencies, self-reported illegal activities for profit, and results from weekly urinalysis testing for opioids and cocaine.

RESULTS

Patients from the NEP were significantly older and more likely to be male, African American, and unemployed than standard referral patients. Needle exchange patients also had a greater baseline severity of drug use than patients in the standard referral group. Despite these baseline differences, both groups achieved comparably good short-term treatment outcomes (including reduced drug use and criminal activity for profit); treatment retention was also good, although slightly better in the standard referral group (88% vs. 76%).

CONCLUSION

These data demonstrate the feasibility and merits of creating strong linkages between NEPs and more comprehensive drug abuse treatment clinics.

Cardiac function, perfusion, and morbidity in irradiated long-term survivors of Hodgkin's disease

PURPOSE

The incidence of cardiotoxicity and clinical cardiac events following mantle irradiation (RT) in patients with Hodgkin's disease using modern techniques is controversial. The use of quantitative, prognostically validated noninvasive tests to assess systolic and diastolic cardiac function and regional myocardial blood flow may reveal preclinical abnormalities associated with subsequent clinical events of myocardial infarction, cardiac death, or angina. The goals of this study are to determine, through noninvasive measures, the presence and time course of alterations in cardiac systolic and diastolic function and of relative myocardial blood flow in long-term survivors of Hodgkin's disease, and assess their correlation with subsequent clinical cardiac end points.

METHODS AND MATERIALS

Equilibrium radionuclide angiocardiography (ERNA) was used to assess left ventricular (LV) systolic and diastolic function by measuring LV ejection fraction (LVEF) and peak filling rate (PFR), respectively, in patients without known ischemic heart disease who received RT. Electrocardiography was performed to assess electrical cardiac function under conditions of rest and either exercise or dipyridamole vasodilator stress. Quantitative rest/stress myocardial perfusion imaging with thallium-201 and/or Tc-99m sestamibi was used to assess myocardial perfusion. Patients at least 1.0 year after RT were eligible if they were <50 years old at RT, had no known cardiac disease, and remained free of clinical recurrence of Hodgkin's disease. Fifty patients, ages 10.2-46.1 years (mean 26.0 +/- 8.6) at RT, were tested 1.1 to 29.1 years (mean 9.1 +/- 7.5) after RT. Seventeen of these patients were tested two times separated by 1.1 to 8.1 years. The mean central cardiac RT dose was 35.1 +/- 7.8 Gy (range 18.5-47.5) in daily 15-2.0 Gy fractions. Twelve patients were concomitantly irradiated to the left ventricle, usually through partial transmission left lung shields (mean 17.0 +/- 2.2 Gy, range 14.3-21.3).

RESULTS

No patients had signs or symptoms of cardiac disease at the time of evaluation. The mean LVEF at the time of initial testing was 59.6 +/- 6.2% (n = 50; range 42-73%; normal > or =50%), and the mean peak filling rate (PFR) was 3.46 +/- 0.88 end diastolic volumes per second (EDV/s) (range 1.5-5.4 EDV/s; normal > or =2.54 EDV/s). The 12 patients also treated to the left ventricle had a normal mean ejection fraction that was lower (56.6 +/- 5.0%) than that of the other 38 patients (LVEF = 60.6 +/- 6.3%, p = 0.051) when initially evaluated. Average PFR was similar in the two groups. For the 15 patients who had repeat tests, changes in LVEF were generally modest in individual patients, and there was no change in the group mean. For all patients, no significant association was found between cardiac function indices and age at RT, dose, or interval from RT to testing. Myocardial perfusion scintigraphy demonstrated mild ischemia in one or more segments in two patients, and borderline normal perfusion in three patients. Rest and stress ECG testing demonstrated mild repolarization abnormalities in three, and one patient was abnormal at rest and had nondiagnostic changes with stress.

CONCLUSIONS

Patients irradiated to the heart incidental to the treatment of Hodgkin's disease using modern techniques have generally normal measures of left ventricular function and myocardial perfusion. Modest differences in the normal left ventricular ejection fraction observed may be attributable to the cardiac volume irradiated. Some patients may manifest improved cardiac function as time from RT elapses, while a significant deterioration of ejection fraction was not observed and reduction in diastolic peak filling rate is uncommon. The previously reported increased risk of cardiac death may relate to use of older techniques of RT employing higher doses and lack of cardiac shielding, and uncontrolled patient selection with additional behaviors and cardiac risk factors.

Clinical and radiographic evaluation of intertrochanteric osteotomy in dogs: a retrospective study of 18 dogs

OBJECTIVE

To determine whether intertrochanteric osteotomy (ITO) can prevent the progression of degenerative joint disease (DJD) in dysplastic hip joints.

STUDY DESIGN

The results of ITO were assessed retrospectively by using owner questionnaires, physical examination, and radiographic evaluation.

ANIMALS

Eighteen client-owned dogs (29 coxofemoral joints were evaluated).

METHODS

Lameness was scored according to a grading system. A scoring system was also developed to assess radiographically evident osteoarthritis on a ventrodorsal projection of the coxofemoral joints in extension.

RESULTS

Twenty-nine ITO were performed in 18 dogs with varying degrees of hip dysplasia. The dogs were lame on 19 of 29 rear limbs on physical examination before surgery. In 22 of the 29 hip joints, palpation caused signs of pain. The median age at the first and second surgical procedure was 14.5 months and 18 months, respectively. Follow-up evaluation was performed on average at 9.77 (FU I), 22.52 (FU II), and 47.50 months (FU III) after surgery. Based on the owners' evaluation, there was a tendency toward improvement after surgery. The results of the physical examination at the preoperative examination and at the three follow-up examinations did not differ significantly. The follow-up radiographic scores showed significantly worse DJD than the preoperative scores.

CONCLUSIONS

ITO does not prevent progression of DJD in the dysplastic hip.

CLINICAL RELEVANCE

Knowledge of the long-term effects of ITO is essential for surgeons trying to achieve improvement in dogs with hip dysplasia.

Evaluation of the effects of nursery depopulation on the persistence of porcine reproductive and respiratory syndrome virus and the productivity of 34 farms

Nursery depopulation has been described as an effective strategy for improving the performance of weaned pigs. In order to assess whether the strategy was effective under a wide range of conditions, a study was carried out on 34 farms in the USA. Four groups with different depopulation protocols were designed on the basis of the location of the depopulated facility (on site vs off site) and the period for which the nursery remained empty (seven days vs 14 days). The changes in average daily liveweight gain, percentage mortality, feed efficiency and treatment cost per pig produced were assessed 12 months before and after nursery depopulation. The ability to eliminate porcine reproductive and respiratory syndrome (PRRS) virus was examined by indirect fluorescent antibody testing of the nursery pigs. Significant improvements (P < 0.0001) were detected in both average daily gain and percentage mortality after depopulation when the differences within an individual group were analysed, but no significant differences (P > 0.14) were observed between the study groups. Serological testing indicated that antibodies to PRRS virus were still present in 14 of the 34 farms after depopulation.

Improved dose distribution in the brain by collimator rotation

Because the head slopes both in the sagittal and lateral directions, the brain is one of the anatomical areas which could benefit by the use of 3-dimensional compensators. The fabrication of 3-dimensional compensators is an expensive and complex task, and as such, not widely used. A standard wedge is often employed to compensate for skull curvature when treating a partial brain area, with the heel of the wedge placed either superior or lateral. This usually results in areas of over- and under dosage in the planning target volume. However, by rotating the collimator 45 degrees while using a standard wedge, with the heel placed superior-lateral, the dose distribution can be significantly improved.

Symptomatic coronary artery disease after mantle irradiation for Hodgkin's disease

PURPOSE

a) To assess the age-related incidence of morbid cardiac events including cardiac death (CD), nonfatal myocardial infarction (MI), and angina pectoris (AP) in all patients treated for Hodgkin's disease at a single institution; b) to examine the prevalence of cardiac risk factors and presence of coronary artery disease (CAD) in affected patients.

METHODS AND MATERIALS

475 patients were treated for Hodgkin's disease in our institution between 1954 and 1989. The status of 97% of the cohort was established either by patient visit and examination in 1992-1993, personal telephone contact, or documentation of death. The 326 of these patients who had mantle irradiation (RT) and survived 3 years formed the study population. Patients who experienced AP, MI, or CD secondary to CAD were assessed for the presence of specific cardiac risk factors. Cardiac catheterization and necropsy data were reviewed to determine the presence and degree of coronary artery stenosis.

RESULTS

Eighteen of 326 patients (5.5%) have had a morbid cardiac event directly related to CAD. Seven patients had CD. Seven patients experienced nonfatal MI, and four patients had AP. The mean interval from RT to morbid cardiac event was 13.1 years (range: 4.4-27.0), and the mean age at the time of the event was 39.4 years (range: 24-65). Four of these patients had morbid cardiac events between ages 24-29 years. Based on US statistics of CD secondary to MI, the relative risk of CD for the treated group was 2.8 (3.1 for males and 1.8 for females). Remarkably, no difference was found in the risk of experiencing a morbid cardiac endpoint in patients stratified by either decile of age at which RT was given, or by duration of follow-up. Only one patient experiencing an event (AP) had received an anthracycline. The mean RT dose to the central cardiac volume for the affected patients was 44.3 Gy (range: 35-60.4). Autopsy or catheterization data were available on 15 patients and revealed 90-100% stenosis of at least one major vessel in 11 patients (73%), and no single artery was more commonly stenosed. Specifically, the left anterior descending and right coronary arteries were each greater than or equal to 60% stenosed in 10 out of 15 patients (67%), and either the left main or circumflex arteries were greater than or equal to 50% stenosed in 5 out of 15 patients (33%); triple vessel disease was present in seven patients. Risk factor data were available on all patients experiencing morbid cardiac events: 72% smoked, 72% were male, 78% had hypercholesterolemia, 61% were obese, 28% had a positive family history, 33% had hypertension, and 6% (one) had diabetes. The average number of risk factors per patient was 2.9; seven patients had at least four risk factors, and all patients had at least one risk factor. This frequency of risk factors is elevated when compared to the US population.

CONCLUSIONS

In our institution, 5.5% of patients treated for Hodgkin's disease experienced a morbid cardiac event following RT to the central cardiac volume. The doses given were greater than commonly used today. Some patients experienced events at a young age, and the likelihood of experiencing CD was increased compared to the general population. This observation is consistent with RT as an additional risk factor in the induction of morbid cardiac events. Appropriate cardiac shielding and radiation doses, careful follow-up, which includes monitoring of cardiac function, and a preventative program of sensible dietary habits, exercise, and nonsmoking may be beneficial in reducing cardiac morbidity in long-term survivors of Hodgkin's disease.

Circadian regulation of Fos-like expression in the brain of the blow fly Calliphora vicina

Expression of Fos-like immunoreactivity (FOS-lir) was examined in the brains of the blow fly Calliphora vicina for evidence of circadian regulation by photic stimuli. Fos-lir in various parts of the brain was investigated as a function of light and time of day. Immunohistochemistry demonstrated that photic stimuli have an inductive effect on c-fos expression in the various parts of the brain, but only in the neurons of the pars intercerebralis did the clear photic induction of c-fos expression occur at times when light was capable of phase-shifting circadian locomotor activity rhythms. This suggests that the c-fos gene may play a role in the photic pathway for circadian entrainment and that these neurons may be involved in the transduction of photic signals. Whether changes in c-fos expression are essential components of this pathway remains to be determined.

Neuronal connections of orbital cortex in rats: topography of cortical and thalamic afferents

The cortical and thalamic afferent connections of rat orbital cortex were investigated using fluorescent retrograde axonal tracers. Each of the four orbital areas has a distinct pattern of connections. Corticocortical connections involving the ventral and ventrolateral orbital areas are more extensive than those of the medial and lateral orbital areas. The medial orbital area has cortical connections with the cingulate, medial agranular (Fr2) and posterior parietal (PPC) cortices. The ventral orbital area has connections with the cingulate area, area Fr2, secondary somatic sensory area Par2, PPC, and visual areas Oc2M and Oc2L. The ventrolateral orbital area (VLO) receives cortical input from insular cortex, area Fr2, somatic sensory areas Par1 and Par2, PPC and Oc2L. The lateral orbital area has cortical connections limited to the agranular and granular insular areas, and Par2. Thalamic afferents to the four orbital fields are also topographically organized, and are focused in the submedial and mediodorsal nuclei. The ventrolateral orbital area receives input from the entirety of the submedial nucleus, whereas the other orbital areas receive input from its periphery only. Each orbital area is connected with a particular segment of the mediodorsal nucleus. The medial orbital area receives its principal thalamic afferents from the parataenial nucleus, the dorsocentral portion of the mediodorsal nucleus, and the ventromedial portion of the submedial nucleus. The ventral orbital area receives input from the lateral segment of the mediodorsal nucleus, the rostromedial portion of the submedial nucleus, and the central lateral nucleus. Thalamic afferents to the ventrolateral orbital area arise from the entirety of the submedial nucleus and from the lateral segment of the mediodorsal nucleus. The lateral orbital area receives thalamic afferents from the central segment of the mediodorsal nucleus, the ventral portion of the submedial nucleus, and the ventromedial nucleus. The paraventricular, ventromedial, rhomboid and reuniens nuclei also provide additional input to the four orbital areas. The connections of the ventrolateral orbital area are interpreted in the context of its role in directed attention and allocentric spatial localization. The present findings provide anatomical support for the view that areas Fr2, PPC and VLO comprise a cortical network mediating such functions.

Effects of intramuscular or interpleural administration of morphine and interpleural administration of bupivacaine on pulmonary function in dogs that have undergone median sternotomy

OBJECTIVE

To evaluate effects of interpleural or IM administration of morphine and interpleural administration of bupivacaine on pulmonary function in dogs that have undergone median sternotomy.

DESIGN

Experimental trial.

ANIMALS

18 healthy dogs.

PROCEDURE

Dogs underwent median sternotomy and were randomly assigned to groups of 6 dogs each. Group-A dogs were given morphine (1.0 mg/kg of body weight) i.m.; group-B dogs were given 0.5% bupivacaine (1.5 mg/kg) interpleurally; and group-C dogs were given morphine (1.0 mg/kg) interpleurally. Heart rate; systolic, diastolic, and mean arterial pressures; rectal temperature; pain score; and arterial blood gas partial pressures were measured and pulmonary function testing was performed immediately after extubation (time 0) and up to 48 hours later. Serum cortisol and morphine concentrations were measured at time 0 and up to 12 hours after surgery.

RESULTS

There was a significant decrease in pH, PaO2, mean oxygen saturation of hemoglobin, and dynamic compliance; and a significant increase in PaCO2, alveolar-arterial difference in partial pressure of oxygen, pulmonary resistance, and work of breathing for dogs in all groups after surgery. Serum cortisol concentrations were significantly increased, compared with preoperative values, in all dogs. Serum cortisol concentrations were significantly higher in group-B dogs between 3 and 5 hours after surgery, compared with group-A dogs.

CONCLUSIONS

Median sternotomy was associated with significant alterations in pulmonary function. Effects of interpleural administration of bupivacaine and morphine were similar to effects of i.m. administration of morphine.

Reflective midwifery practice: facilitating midwives' practice insights using a distance education reflective practitioner model

A study was undertaken to evaluate a reflective practitioner model with midwives, who self-selected into the project when they were studying the Bachelor of Health Science (Nursing) unit NR278, Advanced Nursing Practice, Midwifery. The theoretical assumptions that influenced the research were those forwarded by Schon (1983) and Boud, Keogh and Walker (1985), who argued that practitioners are often unaware of the sophisticated knowledge they have regarding the intricacies of their practice, but that this personal knowledge can be make explicit through reflective processes. The aim of the study was to research the use of a distance education reflective practitioner process that encouraged midwives to examine their practice with a view to making changes where necessary. All the research objectives were met to some extent, although each experience of the research process was particular to the individual participant. Analysis consisted of: interpretation of the participant's insights into their individual experiences; the researcher's interpretations of participant's experiences; and collective themes arising out of the research. This paper concentrates mainly on the participant's insights into their individual experiences of practising midwifery, using a reflective practitioner model.

[Anna, Irma and Dora--the key to the mothers in the creation of psychoanalysis]

As a science caught up between the mythical and the rational, psychoanalysis is subject to the pulls of two opposing currents, a creative enlightened one concerned with the investigation of the unconscious, and a conservative counter-current observable in the psychoanalytic theory of femininity. In her analysis of these warning elements the author goes back to the genesis of psychoanalysis and its creator and takes a close look at the primal myth (the legend of Breuer and Anna O.), the primal dream (Irma), and finally the primal analysis (the case of Dora). King's analysis demonstrates that Freud unconsciously appropriated female psychic features and--in unconscious identification with the mother of the Urszene, bound up with adolescent regression and attendant bi-sexual grandeur fantasies--imagined himself as ideal woman and "conceiver". By appropriating female potency for himself and thus making the opposite sex superfluous, Freud's theory of femininity leaves the place of women vacant, relegating them to the role of a defective entity, a castrated man, rather than acknowledging their otherness. In King's view, this phallic monism is inextricably interwoven with adolescent bisexual identifications and fantasies of grandeur about Freud's own gender, while denying gender-difference genuine recognition and integration.

Effect of glucocorticoids on serum osteocalcin concentration in horses

The effects of dexamethasone (0.2 mg/kg of body weight; IV, IM, and PO) and methylprednisolone acetate (120 mg given intra-articularly) on serum osteocalcin and cortisol concentrations were studied in 6 horses. Serum osteocalcin and cortisol concentrations were serially monitored after each treatment. A significant (P < 0.05) decrease in serum osteocalcin and cortisol concentrations was observed from 12 to 24 and 2 to 48 hours, respectively, after IV and IM administrations of dexamethasone. Serum osteocalcin and cortisol concentrations were significantly decreased from 6 to 48 and 3 to 72 hours, respectively, after oral administration. In contrast, a change in serum osteocalcin concentration was not detected after intra-articular administration of methylprednisolone. Oral, IV, or IM treatment with 0.2 mg of dexamethasone/kg caused a decrease in serum osteocalcin concentration in horses.