The effect of outflow pressure upon thoracic duct lymph flow rate in fetal sheep.

Edema develops when lymph does not return to the venous circulation at a rate equal to the rate of capillary filtration. Fetal sheep develop edema as well as an increased central venous pressure while undergoing atrial pacing at 320 beats per min. We hypothesized that the increased central venous pressure augmented the appearance of fetal edema by impairing the return of thoracic duct lymph to the venous circulation. To investigate this hypothesis, we studied the effect of outflow pressure upon thoracic duct lymph flow in 10 unanesthetized fetal sheep who had low resistance lymph catheters placed in the cervical thoracic duct near its junction with the left jugular vein. After the ewe and fetus recovered for 5 d, we altered the outflow pressure of the lymph catheter by adjusting its height with respect to amniotic fluid pressure and measured the resultant change in thoracic duct lymph flow rate. We found that lymph flow rate was constant over the range of outflow pressures (central venous pressures) normally encountered but decreased in a linear fashion at pressures greater than 0.68 kPa (5.1 torr). Lymph flow stopped at an outflow pressure of 2.40 kPa (18 torr). The data points are best fit by two lines obtained by a piecewise linear regression rather than a single line obtained from a linear regression. We conclude that fetal thoracic duct lymph flow is sensitive to elevations in outflow pressure. Lymph flow begins to diminish at outflow pressures corresponding to central venous pressures commonly encountered in pathologic conditions and may augment the appearance of fetal edema.     

Coemployed spouses: differences,strategies, and discrimination

The authors explore linkages between family and work roles. They examine patterns of apparent economic strategies of spouses working at a southern university located in a rural area. Their research focuses on spousal economic behavior and specifically addresses the effects of spouses' dual employment on the job status of women, differences between spouses in the timing of education and 1st hire at the university, status consistencies in husband and wife employment levels, and sexual discrimination in job levels and income of coemployed spouses. The study uses data extracted from a personnel data set. Cases from a computerized file were identified in 1980-1981, analyzed with 1981-1982 data, and compared with total work force data for 1982-1983. Slightly more than 1/2, or 123 identified cases, were analyzed. Some study findings follow. 1) Marriage to a coemployed spouse is associated with high occupational levels for female employees. 2) It is the husband's career that generally dictates the entry of a couple into the university's internal labor market. 3) There seems to be a strain toward consistency in the status levels of married pairs. 4) Collaborative strategies are being used to secure economic advances for the family unit. Major efforts regarding education and job selection are directed toward advancing the husband's career preference. However, some exceptions suggest that the pattern is flexible and that economic factors will take precedence over stereotyped sex roles when family needs come into consideration. 5) There is employment discrimination by sex at all levels of the internal labor market being studied. Status and income differentials still exist between males and females. Males in the same occupational statuses are paid more than their female counterparts. Females are concentrated at the lower levels of occupational ranks, males toward the top. Although this study is preliminary, it provides partial support for previous research on coemployed spouses' patterns of educational and occupational attainment, and the persistence of sex discrimination in earnings and occupational prestige.     

Comparison of Sinemet CR4 and standard Sinemet: double blind and long-term open trial in parkinsonian patients with fluctuations

"Wearing-off" effect, the most common form of levodopa-induced fluctuations, seems to be related to the short plasma half-life of the drug. More sustained plasma levodopa levels may be achieved with a new controlled-release formulation of carbidopa/levodopa, Sinemet CR4. We studied 20 patients, 12 men and 8 women, with Parkinson's disease complicated by "wearing-off" phenomenon. Mean age was 61.1 +/- 8.1 years, duration of symptoms 8.3 +/- 2.4 years, and the Hoehn-Yahr stage 3.0 +/- 0.9. In a 12-week double-blind study, the average number of tablets administered per day decreased from 5.7 +/- 1.2 to 3.8 +/- 0.7 when Sinemet CR4 (50/200) was substituted for the standard Sinemet (25/100) (p less than 0.001). However, this was at the expense of reducing the "on" time (without dyskinesia) from 9.3 +/- 4.6 to 7.5 +/- 4.3 (p less than 0.05), although the total "on" time did not significantly change. In a long-term follow-up of 18 patients, the "on" time with dyskinesia and morning dystonia significantly increased (p less than 0.05). There was no significant change in the total daily dosage of levodopa, but the daily number of doses and tablets significantly decreased (p less than 0.001). Despite increased dyskinesia, most patients preferred taking fewer tablets and have elected to continue taking Sinemet CR4 instead of standard Sinemet. Sinemet CR4 seems to offer a new and effective strategy for the management of levodopa-related fluctuations.     

Anti-citrullinated protein/peptide antibodies (ACPA) in rheumatoid arthritis: specificity and relation with rheumatoid factor

Anti-citrullinated protein/peptide antibodies (ACPA) are highly specific and sensitive markers for rheumatoid arthritis (RA). For instance, for the anti-CCP2 assay, sensitivities ranging from 55% to 80% and specificities ranging from 90% to 98% have been reported. Despite their high specificity, recent reports have suggested that ACPA may be found in some patients with other rheumatic autoimmune diseases, including psoriatic arthritis, systemic lupus erythematosus and Sj?gren's syndrome. Also, the differences between the classical rheumatoid factor (RF) and ACPA, as well as the complementarity between both tests have recently been demonstrated more clearly. Indeed, both antibody systems have a different association with specific RA features like extra-articular manifestations, a different association with the HLA shared epitope and, behave differently following anti-TNF therapy.     

Psychometric qualities of the rand 36-item health survey 1.0: A multidimensional measure of general health status

The reliability and validity of the RAND 36-Item Health Survey 1.0 were investigated in a population sample of 1,063 inhabitants of a Dutch township, all age 17or older. Confirmatory factor analysisonly partly supported the internal structure of the RAND 36-Item Health Survey 1.0. The internal consistency of the instrument was high. Pointing to high convergent validity, a multitrait-multimelhod matrix revealed that the RAND-36 scales showed higher correlations with corresponding scales from other instruments than with noncorresponding scales. However, indicating low discriminant validity, some of these correlations did not exceed the intercorrelations among the RAND-36 scales. Multivariate analysis of variance (MANOVA) showed significant effects of age for physical functioning, role limitations (physical problem), general health perception and pain, and significant effects of education on physical functioning and general health perception. Significant sex differences were found for mental health only. The results of this study on the psychometric properties of the RAND 36-Item Health Survey 1.0 seem promising. There is a need for further studies investigating its factor structure and cross-cultural equivalence.