Differences in kidney donations between blacks and whites: a retrospective study

The differences in patterns of kidney donation between whites and blacks were examined over a four-year period. A statistically significant difference in living-related kidney donation between blacks and whites was observed: blacks acted as living-related donors far less frequently than their white counterparts.     

Variations on the family resemblance hypothesis as applied to personality disorders

Diagnosis and classification of the personality disorders is controversial and problematic. Diagnostic reliability is uneven because of overlapping of traits and the lack of clear boundaries between categories. This study demonstrates that personality disorder diagnosis is dependent on the total number of defining features. Clinicians tend to ignore the presence of conflicting features when making a diagnosis. A new research instrument, artificially created case histories that allow the specific manipulation of defining features (i.e., diagnostic criteria), is described.     

Bronchial responsiveness to histamine: relationship to diurnal variation of peak flow rate, improvement after bronchodilator, and airway calibre

Features of asthma include increases in both bronchial responsiveness and variability of airflow rates. We examined the relationship between bronchial responsiveness to histamine and the variation of peak expiratory flow rate (PFR) during the day and in response to salbutamol (200 μg), and the initial FEV₁ at the time of the histamine test and FEV₁ response to salbutamol. Bronchial responsiveness to histamine was expressed as the provocation concentration causing a fall in FEV₁ of 20% (PC₂₀). PC₂₀ ranged between 13·9 and 130 mg/ml in nonasthmatic subjects, between 10·5 and 59·9 mg/ml in five asymptomatic asthmatics, and between 0·03 and 20·8 mg/ml in 27 asthmatics with symptoms controlled by medication. The lower the PC₂₀ (the greater the bronchial responsiveness) the lower the morning PFR (r = 0·79), the greater the increase in PFR after salbutamol (morning r = −0·75, evening r = −0·80), and the greater the difference between the highest and lowest PFR each day (r = −0·81). Measurements of PFR were abnormal, compared with those in nonasthmatic subjects, in all subjects with a PC₂₀ less than 2 mg/ml—that is, moderate or severe increase in nonspecific bronchial responsiveness—and in none with a PC₂₀ greater than 21 mg/ml—that is, normal responsiveness; five of nine asthmatics with controlled symptoms had abnormal PFR measurements when PC₂₀ was between 2 and 21 mg/ml—that is, mild hyperresponsiveness. In contrast, FEV₁ at the time of the histamine test was greater than 80% predicted in all subjects with a PC₂₀ greater than 2 mg/ml and was not less than this in 10 of 18 subjects with a PC₂₀ less than 2 mg/ml. When improvement in FEV₁ was 20% or more after salbutamol, the PC₂₀ was usually moderately or severely increased (less than 0·4 mg/ml). The results identify a close relationship between nonspecific bronchial responsiveness to histamine and the variability in flow rates which occurs spontaneously and after bronchodilator. In addition, they raise the possibility that increased airflow obstruction in asthma may be a consequence of increased responsiveness.     

Clinical and research implications of the diagnosis of dysphoric or mixed mania or hypomania.

OBJECTIVE: The authors reviewed available evidence regarding the status of dysphoric or mixed mania as a distinct clinical state and formulated operational criteria for its diagnosis. METHOD: Studies of dysphoric mania or hypomania in patients with bipolar disorder were analyzed with regard to clinical characteristics, prevalence, demographic features, course of illness, outcome, family history, associated conditions, biological tests, and response to biological treatment. RESULTS: Although some studies suggest that dysphoric and nondysphoric mania are similar conditions, others suggest that, compared with nondysphoric mania, dysphoric mania may be more severe; more likely to occur in women; more likely to be associated with suicidality, a younger age at onset, a longer duration of illness, higher rates of personal and familial depression, concomitant alcohol or sedative-hypnotic abuse, neuropsychiatric abnormalities, and poorer outcome; more frequently associated with cortisol nonsuppression; and less likely to respond adequately to lithium but perhaps more likely to respond to ECT or anticonvulsants. CONCLUSIONS: Substantial evidence suggests that dysphoric mania may be a distinct affective state. Contrary evidence, however, suggests that dysphoric mania may be a form of typical mania, a stage-related or severe form of mania, or a transitional state between mania and depression. Because the evidence may be inconsistent because of varying definitions of dysphoric mania among studies, the authors propose preliminary operational diagnostic criteria for the future study of dysphoric mania.     

Outcome of patients admitted to an acute geriatric medical unit

To find out what happens to patients admitted to an acute geriatric medical unit, all admissions during 1982 were reviewed. Demographic features were compared with those of the community served, and rehabilitation, inpatient mortality and mortality in the year following discharge were assessed. Inpatients accounted for 4% of the community aged over 65, and most patients were discharged back to the community. Inpatient mortality was 25% and mortality in the year following discharge was 23%, giving a two year mortality of 42%, which was similar in all age groups. The achievement of high rehabilitation rates was tempered by the considerable mortality rates following discharge.     

Exfoliated colonic epithelial cells: surrogate targets for evaluation of bioactive food components in cancer prevention

There is significant evidence supporting the hypotheses that lifestyle, diet, and bioactive components in foods are important modifiers of cancer risk. However, our ability to assess host response noninvasively is limited. To overcome this, we have developed a technology to isolate several million viable exfoliated somatic colonic cells from a small sample of stool (0.5-1.0 g) by a procedure known as somatic cell sampling and recovery (SCSR). Orally administered carotenoids appear in these cells several days after consuming the supplement, usually showing a peak concentration between 5-7 d after their ingestion. The time lag observed for the appearance of orally administered carotenoids in SCSR cells corresponds to the turnover rate of the colonic mucosa. This is an example of how changes in cell turnover rates can be carefully assessed using the SCSR system. The specific mechanisms by which individual constituents of diet affect the cancer process are not fully understood. However, host response to dietary constituents may be investigated, noninvasively, by following the modulation of tumor-associated molecular markers in these exfoliated SCSR cells. We have demonstrated the feasibility of using SCSR cells to detect the expression of carcinoembryonic antigen, CD44, and its splice variants, c-myc, c-erbb2, and mutations in the p53 gene. In this regard, SCSR cells are a readily available surrogate cellular target that may serve to monitor changes in cell turnover, differentiation, and expression of cancer-associated biomarkers that are likely to be modulated by bioactive food components.     

Empiric validation of the rural Australian Medical Undergraduate Scholarship 'rural background' criterion

OBJECTIVE: Rural Australian Medical Undergraduate Scholarships (RAMUS) provide 10,000 dollars per annum to selected medical students with a rural background. Eligibility criteria include having lived in a rural community for five consecutive or eight cumulative years. We sought to validate the above-specified criterion using data from the Australian National Rural Background Study. DESIGN: National case control study stratified by jurisdiction. PARTICIPANTS: Two thousand four hundred and fourteen Australian-trained rural and urban general practitioners (GPs). MAIN OUTCOME MEASURE: Whether the RAMUS rural background criterion was met or not. RESULTS: Doctors who met the RAMUS rural background criterion were more likely to be in rural practice (odds ratio = 2.50; 95% confidence interval, 1.97-3.18) than those who did not. This was true for all jurisdictions (except for the Northern Territory) and ranged from 1.95 for South Australia to 3.57 for Victoria. CONCLUSION: Rural GPs are more likely to fulfil the RAMUS rural background criterion, supporting the existence of the RAMUS scheme.     

Mechanisms of B cell tolerance. II. Evidence for inhibition of antigen receptor expression as a mechanism of unresponsiveness.

The experiments reported examined the fate and properties of antigen-binding B cells (ABC) during the induction of hapten-specific tolerance by 2,4-dinitrophenyl (DNP)-conjugated type 3 pneumococcal polysaccharide (S3). We found that (a) after short (nontolerogenic) pulses of DNP-S3, anti-DNP Ig receptors were physically blocked by cell-bound antigen. Removal of extracellular tolerogen led to full functional recovery of ABC. (b) After more prolonged (tolerogenic) exposures to DNP-S3 the degree of recovery of ABC following antigen-free culture was inversely related to the dose of antigen given, (c) Regardless of the dose or duration of exposure to DNP-S3, cells initially binding antigen effectively cleared it from their membranes; after tolerogenic exposures, cells neither carried cell-bound DNP-S3, nor expressed functional receptors, (d) Under conditions where tolerized cells recovered near normal levels of ABC after removal of extracellular antigen, these ABC appeared to display fewer receptors per cell than normal. We therefore propose that B cell inactivation by DNP-S3 involves the progressive and eventually irreversible inhibition of Ig receptor expression on DNP-reactive B cells, and is not due to stable blockade of receptors by cell-bound antigen. The relationship of this effect to other models of B cell inactivation (especially the similar phenomenon seen in immature B cells exposed to anti-receptor antisera) is discussed.