Interrelationships of general internal medicine and preventive/community medicine

Clinical preventive medicine, efforts by clinicians to prevent disease in individual patients, is an important component of preventive medicine as a whole. Yet clinicians, including internists, apparently do not provide many preventive services of established effectiveness. This paper describes one approach to improving the practice of clinical preventive medicine: increased cooperation between general internists--one of the nation's largest groups of primary care physicians--and specialists in preventive/community medicine. The paper summarizes a larger report prepared by two societies representing these disciplines: the Society for Research and Education in Primary Care Internal Medicine and the Association of Teachers of Preventive Medicine. It was found that the two disciplines have many common goals, and much to offer each other, but do not often collaborate. The report concludes with 14 recommendations for improving the practice of clinical preventive medicine, which suggest that such improvement can be achieved in part through strengthening working relationships between general internists and preventive/community medicine specialists.     

Theory of Mind and Rule Use in Individuals With Down's Syndrome: A Test of the Uniqueness and Specificity Claims

The relationship between Theory of Mind (ToM) and rule use was explored in adults with Downs Syndrome (DS) and in non-handicapped pre-schoolers. Twelve low-functioning individuals with DS (mean mental age = 5.1 years, mean chronological age = 22.7) performed worse than 12 MA-matchcd non-handicapped children (mean MA =5.1 years) on several standard ToM tasks and on a color-shape card-sorting task in which subjects were required to switch between two incompatible sets of rules. On the ToM tasks, people with DS tended to focus on a single slate of affairs (e.g. the present situation). Likewise, on the card sort. these subjects tended to use a single set of rules on all trials. Performance in the two types of [ask was positively correlated when MA was partialed out. The results are inconsistent with the claim that ToM reflects a domain-specific psychological function and the notion that deficits in ToM are unique to individuals with autism. Copyright © 1996 Association for Child Psychology and Psychiatry.     

Improved vessel dilator for percutaneous catheterization

Three commercial vessel dilators and a dilator of an improved design were tested during percutaneous catheterization in 16 mongrel dogs to evaluate arterial damage produced with their use. The results indicate that, although all dilators often produce arterial damage, the improved design produced much less damage. In addition, lesions were less severe overall. The dilator has been safely and successfully used in patients for percutaneous vessel catheterization for the past 30 years at the authors' institution.     

P-(3-酰氨基-4-取代苯基-2-吖丁啶酮基-1)-苯乙酸和P-(3-酰氨基-4-取代苯基-2-吖丁啶酮基-1)-苯乙酮的合成及抑制β-内酰胺酶作用

为研究吸电子基团远离环氮的单环β-内酰胺类化合物对β-内酰胺酶的抑制作用,设计与合成了21个新的p-(3-酰氨基-4-取代苯基-2-吖丁啶酮基-1)苯乙酸和p-(3-酰氨基-4-取代苯基-2-吖丁啶酮基-1)苯乙酮类化合物,经元素分析、红外光谱、核磁共振氢谱和质谱证实。生物活性测定表明,其中15个具有游离羧基的水溶性化合物对试验的腊样芽胞杆菌和绿脓杆菌产生的β-内酰胺酶有抑制作用。     

Sorting and directed transport of membrane proteins during development of hippocampal neurons in culture

Hippocampal neurons in culture develop morphological polarity in a sequential pattern; axons form before dendrites. Molecular differences, particularly those of membrane proteins, underlie the functional polarity of these domains, yet little is known about the temporal relationship between membrane protein polarization and morphological polarization. We took advantage of viral expression systems to determine when during development the polarization of membrane proteins arises. All markers were unpolarized in neurons before axonogenesis. In neurons with a morphologically distinguishable axon, even on the first day in culture, both axonal and dendritic proteins were polarized. The degree of polarization at these early stages was somewhat less than in mature cells and varied from cell to cell. The cellular mechanism responsible for the polarization of the dendritic marker protein transferrin receptor (TfR) in mature cells centers on directed transport to the dendritic domain. To examine the relationship between cell surface polarization and transport, we assessed the selectivity of transport by live cell imaging. TfR-green fluorescent protein-containing vesicles were already preferentially transported into dendrites at 2 days, the earliest time point we could measure. The selectivity of transport also varied somewhat among cells, and the amount of TfR-green fluorescent protein fluorescence on intracellular structures within the axon correlated with the amount of cell surface expression. This observation implies that selective microtubule-based transport is the primary mechanism that underlies the polarization of TfR on the cell surface. By 5 days in culture, the extent of polarization on the cell surface and the selectivity of transport reached mature levels.     

Purging murine leukemic marrow with alkyl-lysophospholipids

Autologous bone marrow transplantation is potentially curative in the treatment of acute leukemia if residual leukemic cells in the marrow can be eliminated prior to transplantation. We studied the purging effects of a synthetic alkyl-lysophospholipid (ALP) on marrow containing leukemic cells from a transplantable myelomonocytic leukemia (WEHI-3B) in BALB/c mice. Simulated remission bone marrow containing 2% leukemic cells treated in vitro with 20 and 100 micrograms/mL of ET-18- OCH3 (1-octadecyl-2-methyl-sn-glycerol-3-phosphocholine) significantly prolonged survival of lethally irradiated transplanted recipients. At a dose of 100 micrograms/mL, 88% of the mice survived for the duration of the experiment (approximately five months). Autopsies showed that 25% of these survivors had microscopic evidence of leukemia. Thus, in vitro treatment of marrow eliminated leukemic blasts and spared sufficient normal stem cells to allow hematologic reconstitution. The effect of ET- 18-OCH3 is not entirely selective for leukemic cells. A spleen colony assay showed that ALP has some cytotoxic effect on normal hematopoietic stem cells.     

Effect of natural killer cells on syngeneic bone marrow: in vitro and in vivo studies demonstrating graft failure due to NK cells in an identical twin treated by bone marrow transplantation

Bone marrow transplantation for severe idiopathic aplastic anemia was undertaken in a patient, using his monozygotic twin brother as the donor. In spite of the use of syngeneic bone marrow, failure of engraftment occurred on two occasions. In vitro studies demonstrated that natural killer (NK) cells from the recipient markedly inhibited the growth of donor bone marrow granulocyte progenitor cells. On a third attempt, successful bone marrow engraftment was achieved following high-dose cyclophosphamide, which has previously been shown to be inhibitory to NK cells. We conclude that NK cell activity may play an important role in bone marrow failure as well as being responsible for at least some cases of aplastic anemia.