Macro- and microanatomy of the lateral border of the tongue with special reference to oral hairy leukoplakia

The macro- and microanatomy of the marginal tongue mucosa were studied. Tissues were harvested from 12 individuals at autopsy. Random sections from six different locations along the margin and serial sections representing three defined section planes to the margin of the tongue were evaluated. Vertical, parallel mucosal folds alternating with shallow grooves were a characteristic macroscopical findings on the lateral border of the tongue. The mucosa presented a non-keratinized epithelium with PAS-positive, lightly stained spinous cells and no or slight inflammatory reaction in the connective tissue. Changes in the epithelium mimicking hyperplasia, acanthosis, keratin projections, and focal parakeratosis could be produced by changing the direction of tissue sectioning. The macro- and microscopical parameters recorded in normal marginal tongue mucosa are among other included in criteria for diagnosing oral hairy leukoplakia. The results emphasize the importance of a thorough knowledge of the normal anatomy of a mucosal site to arrive at reliable diagnostic criteria.     

Late complications of asymptomatic deep venous thrombosis.

Forty-one patients who had all participated in studies about prophylaxis of postoperative deep venous thrombosis (DVT) were investigated 5-8 years after operation. Twenty-five had had asymptomatic DVT detected by 125I-fibrinogen uptake test or 99mTc plasmin scintigraphy and verified by phlebography, four of which were bilateral. They received anticoagulant treatment for three months. Sixteen patients had normal screening tests. At the follow up legs in which DVT had previously been diagnosed were compared with normal legs in patients who did not have DVT. There was no significant difference in subjective symptoms between the two groups of legs, although there were more complaints of oedema and restlessness in legs in which DVT had been diagnosed and varicose veins were more common. When the incidence of varicose veins before the operation and at the follow up was compared, more patients who had had a DVT had developed varicose veins. Blood volume and venous refilling time were measured by strain gauge plethysmography, and were significantly lower in those with a history of DVT than in normal legs. The results indicate impaired venous function in patients who previously had had asymptomatic DVT treated with anticoagulants.     

UPBEAT: the impact of a psychogeriatric intervention in VA medical centers. Unified Psychogeriatric Biopsychosocial Evaluation and Treatment

BACKGROUND: The Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) program provides individualized interdisciplinary mental health treatment and care coordination to elderly veterans whose comorbid depression, anxiety, or alcohol abuse may result in overuse of inpatient services and underuse of outpatient services. OBJECTIVES: To determine whether proactive screening of hospitalized patients can identify unrecognized comorbid psychiatric conditions and whether comprehensive assessment and psychogeriatric intervention can improve care while reducing inpatient use. DESIGN: Randomized trial. SUBJECTS: Veterans aged 60 and older hospitalized for nonpsychiatric medical or surgical treatment in 9 VA sites (UPBEAT, 814; usual care, 873). MEASURES: The Mental Health Inventory (MHI) anxiety and depression subscales, the Alcohol Use Disorder Identification Test (AUDIT) scores, RAND 36-Item Health Survey Short Form (SF-36), inpatient days and costs, ambulatory care clinic stops and costs, and mortality and readmission rates. RESULTS: Mental health and general health status scores improved equally from baseline to 12-month follow-up in both groups. UPBEAT increased outpatient costs by $1,171 (P <0.001) per patient, but lowered inpatient costs by $3,027 (P = 0.017), for an overall savings of $1,856 (P = 0.156). Inpatient savings were attributable to fewer bed days of care (3.30 days; P = 0.016) rather than fewer admissions. Patients with 1 or more pre-enrollment and postenrollment hospitalizations had the greatest overall savings ($6,015; P = 0.069). CONCLUSIONS: UPBEAT appears to accelerate the transition from inpatient to outpatient care for acute nonpsychiatric admissions. Care coordination and increased access to ambulatory psychiatric services produces similar improvement in mental health and general health status as usual care.     

Evaluation of the permeation characteristics of a model opioid peptide,H-Tyr-D-Ala-Gly-Phe-D-Leu-OH (DADLE), and its cyclic prodrugs across the blood-brain barrier using an in situ perfused rat brain model

The permeation characteristics of a model opioid peptide, H-Tyr-D-Ala-Gly-Phe-D-Leu-OH (DADLE), and its cyclic prodrugs [acyloxyalkoxy-based cyclic prodrug of DADLE (AOA-DADLE), coumarinic acid-based cyclic prodrug of DADLE (CA-DALE), and oxymethyl-modified coumarinic acid-based cyclic prodrug of DADLE (OMCA-DADLE)] across the blood-brain barrier (BBB) were determined using an in situ perfused rat brain model. The rat brains were perfused with Krebs-bicarbonate buffer containing test compounds in the absence or presence of a specific P-glycoprotein inhibitor (GF-120918). Brain samples were collected after perfusion and processed by a capillary depletion method. After liquid phase extraction with acetonitrile, samples were analyzed using high-performance liquid chromatography with tandem mass spectrometric detection. Linear uptake kinetics of DADLE and its cyclic prodrugs was observed within the range of 60 to 240 s of perfusion. The apparent permeability coefficient (P(app)) of DADLE across the BBB was very low (<10(-7) cm/s), probably due to its unfavorable physicochemical properties (e.g., charge, hydrophilicity, and high hydrogen-bonding potential). All three cyclic prodrugs, however, also exhibited low membrane permeation (P(app) <10(-7) cm/s) in spite of their more favorable physicochemical properties (e.g., no charge, high hydrophobicity, and low hydrogen-bonding potential). Inclusion of GF-120918 (10 microM) in the perfusates fully inhibited the P-gp activity in the BBB and dramatically increased the P(app) values of AOA-DADLE, CA-DADLE, and OMCA-DADLE by approximately 50-, 460-, and 170-fold, respectively. In contrast, GF-120918 had no effect on the P(app) value of DADLE. In addition, the observed bioconversions of the prodrugs to DADLE in the rat brains after 240-s perfusion were very low (5.1% from AOA-DADLE, 0.6% from CA-DADLE, and 0.2% from OMCA-DADLE), which was consistent with the in vitro bioconversion rates determined previously in rat brain homogenates.     

The world’s ten most feared fungi

An account is provided of the world’s ten most feared fungi. Within areas of interest, we have organized the entries in the order of concern. We put four human pathogens first as this is of concern to most people. This is followed by fungi producing mycotoxins that are highly harmful for humans; Aspergillus flavus, the main producer of aflatoxins, was used as an example. Problems due to indoor air fungi may also directly affect our health and we use Stachybotrys chartarum as an example. Not everyone collects and eats edible mushrooms. However, fatalities caused by mushroom intoxications often make news headlines and therefore we include one of the most poisonous of all mushrooms, Amanita phalloides, as an example. We then move on to the fungi that damage our dwellings causing serious anxiety by rotting our timber structures and flooring. Serpula lacrymans, which causes dry rot is an excellent example. The next example serves to represent all plant and forest pathogens. Here we chose Austropuccinia psidii as it is causing devastating effects in Australia and will probably do likewise in New Zealand. Finally, we chose an important amphibian pathogen which is causing serious declines in the numbers of frogs and other amphibians worldwide. Although we target the top ten most feared fungi, numerous others are causing serious concern to human health, plant production, forestry, other animals and our factories and dwellings. By highlighting ten feared fungi as an example, we aim to promote public awareness of the cost and importance of fungi.     

Intestinal transplantation in pediatric patients: a nursing challenge. Part 2: Intestinal transplantation and the immediate postoperative period.

Intestinal transplantation offers new hope to children with intestinal failure and life-threatening complications of parenteral nutrition. As more transplant centers are adding intestinal transplantation to their existing programs, new challenges are presented to nursing professionals. This three-part series will provide information for nursing professionals regarding evaluation for intestinal transplantation, donor preparation, the surgical procedure, immediate postoperative care of the transplant recipient, and long-term care of the intestinal transplant recipient. This article focuses on donor selection and preparation, the surgical procedure for intestinal transplantation, the immediate postoperative course, immunosuppression, rejection, infections, fluid and electrolyte support, and nutrition. The information presented represents the approach taken at University of Nebraska Medical Center/Nebraska Health Systems.     

Effects of mechlorethamine on lysosomal enzyme release from HeLa and 3T3 cells

The growth of the established malignant HeLa cells was much more inhibited by mechlorethamine (HN2) than that of the nonmalignant 3T3 cells. An initial growth inhibition was followed by complete inhibition even if HN2 was removed from the culture medium. Significant cell death did not occur during the first 24 h of HN2 treatment, but well later on. Incubation with 2.5 micrograms/ml HN2 caused increased release of lysosomal enzymes into the medium and decreased intracellular enzyme activities after a latency period of at least 6 h. The lysosomes from HeLa cells did not seem to be more fragile than those from 3T3 cells. Incubation with 0.25 micrograms/ml HN2 did not alter the intra- or extracellular enzyme levels the first 24 h, but well later on even after refeeding with medium without HN2. This study indicates that lysosomal enzymes are not involved in the genesis of the process leading to cell inactivation by HN2, but may well be correlated with the cytotoxic effects leading to cell death.     

Doppler tissue imaging reveals systolic dysfunction in patients with hypertension and apparent "isolated" diastolic dysfunction.

The purpose of this study was to examine left ventricular systolic longitudinal contraction in patients with essential hypertension with normal ejection fraction and fractional shortening. We used tissue tracking and strain rate Doppler echocardiography to evaluate left ventricular longitudinal contraction in 40 patients with hypertension and 30 age-matched control patients. Tissue tracking and peak systolic strain rate were significantly decreased in patients with hypertension and diastolic dysfunction compared with patients with hypertension and normal diastolic function or with control patients. In conclusion, patients with hypertension who, earlier, were considered to have isolated diastolic dysfunction were demonstrated to have reduced left ventricular systolic longitudinal function.     

Hand strengthening exercises in chronic stroke patients: Dose-response evaluation using electromyography

Study Design

Cross-sectional.