45-Hour continuous quintuple-site actimetry: Relations between trunk and limb movements and effects of circadian sleep-wake rhythmicity

Diurnal and nocturnal trunk and limb motor activity of 20 healthy individuals was evaluated by actimetry for 45 consecutive hours. Sleep was assessed by sleep logs. Overall, motor activity significantly (p < .05) decreased in the order wrist, ankle, and trunk. There was significantly more motor activity in the dominant wrist during the diurnal period. Motor activity was significantly affected by the 24-hr sleep-wake cycle, with lower levels and prolonged immobility during the night. Time series analyses revealed different but significant correlations between motor activity at all sites. These data imply that (a) motor activity should be recorded at the dominant wrist when the highest level of motor activity is of importance, (b) recordings at the nondominant wrist are better indicators of trunk movement than are dominant wrist recordings, and (c) sites other than the conventional nondominant wrist recording site should be evaluated to improve the validity of motor activity-based sleep-wake scoring.     

Electrophysiological Effects of Monophasic and Biphasic Stimuli in Normal and Infarcted Dogs

Though some biphasic waveforms significantly decrease the energy required for defibrillation, little is known about the effect of biphasic stimulation on the determination of other electrophysiological parameters in normal and infarcted hearts. To evaluate this, nine normal dogs and 12 dogs with myocardial infarction had activation threshold (AT), effective refractory period (ERP), strength-interval curves, and ventricular fibrillation threshold (VFT) determined with constant current stimulation to a pair of right ventricular plunge electrodes, and upper limit of vulnerability (ULV) and defibrillation threshold (DFT) determined with truncated exponential shocks delivered to a pair of wire electrodes coiled to contour the right and left ventricular epicardium. Each electrophysiological parameter was determined with a 5.5 msec monophasic and 5.5-msec biphasic (3.5 msec first phase) waveform. Though AT and VFT were not significantly different for the two waveforms, the ERP was significantly longer, the strength-interval curve shifted rightward, and the threshold for repetitive responses higher for biphasic stimuli. Compared to the monophasic waveform, the ULV and DFT were significantly decreased in a parallel fashion for the biphasic waveform. Neither the presence nor size of myocardial infarction significantly affected any of the measured electrophysiological parameters. In six additional dogs, sigmoid defibrillation probability curves were constructed from biphasic shocks of four energies including that of the DFT and ULV. The ULV energy predicted an effective dose that defibrillated 97% of the time (range 90%-100%). In conclusion, the increased defibrillation efficacy of the biphasic waveform is independent of its ability to activate fully repolarized myocardium and cannot be explained by a greater ability of biphasic waveforms to activate partially depolarized tissue. The parallel decrease in the ULV and DFT for biphasic stimulation and the finding that the ULV energy defibrillates with a high probability of success suggest similar underlying mechanisms for the ULV and defibrillation.     

Inhibition of binding of phospholipase Cγ1 SH2 domains to phosphorylated epidermal growth factor receptor by phosphorylated peptides

A series of tyrosine-containing peptides 1–12: Asp-Ala-Asp-Glu-Tyr⁹⁹²(PO₃H₂)-Leu-Ile-Pro-Gln-Gln-Gly-OH (1) Asp-Ala-Asp-Glu-Tyr⁹⁹² -Leu-Ile-Pro-Gln-Gln-Gly-OH (2) Phe-Leu-Pro-Val-Pro-Glu-Tyr¹⁰⁶⁸(PO₃H₂)-Ile-Asn-Gln-Ser-Val-OH (3) Phe-Leu-Pro-Val-Pro-Glu-Tyr¹⁰⁶⁸ -Ile-Asn-Gln-Ser-Val-OH (4) Asp-Asn-Pro-Asp-Tyr¹¹⁴⁸JR(PO₃H₂)-Gln-Gln-Asp-Phe-Phe-OH (5) Asp-Asn-Pro-Asp-Tyr¹¹⁴⁸ -Gln-Gln-Asp-Phe-Phe-OH (6) Ala-Glu-Tyr¹¹⁷³(PO₃H₂)-Leu-Arg-Val-Ala-Pro-Gln-Ser-OH (7) Ala-Glu-Tyr¹¹⁷³ -Leu-Arg-Val-Ala-Pro-Gln-Ser-OH (8) Ala-Glu-Tyr¹¹⁷³(PO₃H₂)-Leu-Arg-Val-Ala-OH (9) Ala-Glu-Tyr¹¹⁷³ -Leu-Arg-Val-Ala-OH (10) Tyrl¹¹⁷³(PO₃H₂)-Leu-Arg-Val-Ala-Pro-Gln-Ser-OH (11) Tyr¹¹⁷³ -Leu-Arg-Val-Ala-Pro-Gln-Ser-OH (12) (six pairs with and without the tyrosine phosphorylated) has been synthesized. The peptides were derived from tyrosine autophosphorylation sites in the epidermal growth factor receptor (EGFR): Tyr 992, 1068, 1148 and 1173. Peptide 1, derived from the Tyr 992 site, inhibited binding of a ³⁵S-labelled fusion protein containing both of the SH2 domains from PLCγ1 to the phosphorylated EGFR with an IC₅₀ of 8 μM. All of the phosphorylated peptides except 11 (1, 3, 5, 7 and 9) inhibited this binding to some degree (20–55%) at 10 p μM. The nonphosphorylated peptides were inactive in this assay. The nonphosphorylated peptides 2, 4, 6, 8, 10 and 12 were obtained by standard solid-phase synthetic methodologies using both Boc/benzyl and Fmoc/tert-butyl strategies. The phosphorylated peptides 1, 3, 5, 7, 9 and 11 were similarly obtained using a Fmoc/tert-butyl strategy incorporating unprotected N^x-Fmoc-Tyr, followed by phosphitylation and oxidation of the tyrosine in the resin-bound peptide. In addition, Asp-Ala-Asp-Glu-Phe⁹⁹²(4-CH₂PO₃H₂)-Leu-Ile-Pro-Gln-Gln-Gly-OH (15), an analog of 1 incorporating an enzymatically stable phosphotyrosine mimic, 4-phosphonomethyl-l -phenylalanine, was synthesized and found to be inactive.     

Extensive Leukemic Infiltration of the Gastrointestinal Tract during Apparent Remission in Acute Leukemia

A child with acute leukemia in an apparent hematologic remission whosuccumbed to the complications arising from extensive leukemic infiltrationof the gastrointestinal tract is reported.

This cannot be explained by any unique anatomical properties of the circulation, such as have been proposed for central nervous system infiltration undersimilar circumstances.

Submitted on November 19, 1962 Accepted on March 1, 1963     

Pelvic Exenteration: A Nursing Challenge

Pelvic exenteration, a radical surgical procedure usually performed for recurrent cancer of the cervix, results in changes in body function and appearance requiring extraordinary physical, emotional, and sexual adjustments by the patient and deeply affecting her immediate family. Her health care needs are best met when a primary care nurse is available to provide continuity from the initial contact with the gynecologic oncologist through convalescence at home. It is necessary that the nurse understand some of the problems in surgical management, pre- and postoperative physical care, and healing in order to deal with certain aspects of care. During convalescence, emphasis should be placed on the use of support and education to assist the patient in coping with tremendous body changes.     

Regional perinatal mortality and regional hospitalization at delivery in The Netherlands

Summary. In The Netherlands 34–35 % of all deliveries still take place at home, but with considerable regional differences. A study was made of the relation between the perinatal mortality rate and the percentage of hospital deliveries in the 11 provinces of The Netherlands, in municipalities divided into groups according to the number of inhabitants, and in the 17 cities with more than 100 000 inhabitants. No relation could be demonstrated between the regional percentage of hospital deliveries and the regional perinatal mortality rate. The proportion of hospital delivery appears not to be a major factor determining the regional perinatal mortality rate in the current system of obstetric care in The Netherlands.