Aural symptoms and hearing loss in patients with lupus

OBJECTIVE: Systemic lupus erythematosus causes widespread tissue injury from deposition of immune complexes. The prevalence of aural symptoms in this disease was evaluated. METHODS: The presence of tinnitus, hearing loss, and fluctuating hearing was evaluated by a self-directed questionnaire in patients aged 65 or less from a lupus clinic. Patients reporting aural symptoms were compared with those reporting none, by use of demographics and disease duration. Comparison was also made with historic serologic data. Audiometry was offered to all patients with lupus reporting aural symptoms and was completed in 10. RESULTS: Twenty-six (31%) of 84 patients with lupus reported aural symptoms. Patients reported a combination of symptoms: unilateral hearing loss with or without tinnitus in 13 (15%) of 84 and bilateral hearing loss with or without tinnitus in 14 (17%) of 84. No statistical difference was measured between symptomatic and asymptomatic patients when compared by average age, duration of disease, history of noise exposure, head trauma, and infectious ear diseases. Statistically significant differences were detected only when comparing average creatinine and C3 levels. Of those patients tested by audiometry, 7 of 10 had abnormal pure-tone thresholds. Asymmetric findings were present in 6 of these 7 patients tested. CONCLUSION: Aural symptoms are prevalent among patients with lupus. Asymmetric symptoms and hearing loss are most common. The cause may relate to immune-complex disease and/or vasculitis. (Otolaryngol Head Neck Surg 1998;118:762-5.)     

The use of Roy's adaptation model applied to a patient with breast cancer

Roy's adaptation model provides a framework for holistic oncology nursing practice. In this article an overview of Roy's model is provided, and the model is applied to a patient with breast cancer for an assessment of behaviour and the stimuli influencing behaviour, and for the planning and evaluation of nursing care. Also, a comprehensive list of nursing diagnoses is categorized according to Roy's four adaptive modes.     

Sensitivity of Entamoeba histolytica and Entamoeba dispar patient isolates to human complement

Twenty-one Entamoeba histolytica and 56 Entamoeba dispar patient isolates were investigated for their sensitivity to the classical and alternative pathway of human complement. E. histolytica and E. dispar patient isolates were differentiated by polymerase chain reaction and hexokinase isoenzyme typing. It was found that 90.3% (±12.0%) of the trophozoites of E. histolytica were lysed after 30 min by the alternative pathway of complement in the presence of 50% human serum (19 isolates showed lysis rates higher than 80%), whereas E. dispar cells were less susceptible to the alternative pathway as 68.8% (±28.2%) of lysis occurred. However, 23 of the E. dispar isolates were lysed between 100 and 80% (90.9%±9.1%), demonstrating that about half of the tested E. dispar isolates were highly sensitive to complement lysis. Only 11 of the E. dispar isolates were proven to be 'resistant' to the alternative pathway of complement and were lysed less than 40%. These results are in conflict to earlier publications, describing resistance of E. dispar to complement lysis (Hamelmann et al. 1992, 1993).     

Three-dimensional structure of bradykinin in SDS micelles

The conformational properties of bradykinin in five molar excess sodium dodecyl sulfate (SDS) micelles have been examined by two-dimensional nuclear magnetic resonance (NMR) techniques at 500 MHz. Detailed structural information for bradykinin in SDS was obtained from quantitative 2-D nuclear Over-hauser enhancement (n.O.e.) analyses, distance geometry, and restrained molecular mechanics and dynamics calculations. The conformation of bradykinin in SDS micelles, as determined by these methods, is characterized by a β-turn-like structure at residues 6–9. A detailed comparison of the structures derived from distance geometry and restrained molecular mechanics and dynamics is also presented.     

Chemical synthesis and characterization of peptides and oligomeric proteins designed to form transmembrane ion channels

A strategy for the synthesis of peptides and oligomeric proteins designed to form transmembrane ion channels is described. A folding motif that exhibits a functional ionic pore encompasses amphipathic α-helices organized as a four-helix bundle around a central hydrophilic pore. The channel-forming activity of monomeric amphipathic peptides may be examined after reconstitution in lipid bilayers in which peptides self-assemble into conductive oligomers. The covalent attachment of channel-forming peptides to the lysine ε-amino groups of a template molecule (KKKPGKEKG) specifies oligomeric number and facilitates the study of ionic permeation and channel blockade. Here we describe detailed protocols for the total synthesis of peptides and template-assembled four-helix bundle proteins, exemplified with the sequence of M2δ (EKM-STAISVLLAQAVFLLLTSQR), considered involved in lining the pore of the nicotinic acetylcholine receptor channel. For comparison, the synthesis of a second four-helix bundle, T₄CaIVS3 with the sequence of predicted transmembrane segment S3 (DPWNVFDFLIVIGSIIDVILSE) of the fourth repeat of the l -type voltage-gated calcium channel, is included. Peptides and proteins are synthesized step-wise by solid-phase methods, purified by reversed-phase HPLC, and homogeneity ascertained by analytical HPLC, capillary zone electrophoresis, SDS/PAGE, amino acid analysis and sequencing. Optimization of synthetic procedures for hydrophobic molecules include reducing resin substitution to avoid steric hindrance and aggregation of the final product. Protocols for the preparation of the samples prior to HPLC purification as well as the conditions and columns required for successful purification are presented. The methods developed are generally applicable for the chemical synthesis, purification and characterization of amphipathic peptides and template directed helical bundle proteins.     

How many hysterectomies should purchasers buy?

In the reorganized British National Health Service (NHS), purchasersare supposed to assess the health care requirements of theirresident populations and contract for an appropriate volumeof services. In the case of elective surgical procedures thiscan be problematic when there is no reliable information onhealth needs and no consensus on appropriate rates of use. Anexamination of hysterectomy rates in 8 districts in 1 RegionalHealth Authority found a nearly 2-fold variation in population-basedrates, a difference which had persisted for at least 12 years.A detailed comparison of a high- and a low-rate district wasconducted to assess the extent to which the variations in therates were related to indices of data quality, resource availability,use of alternative surgical procedures, use of private hospitals,differences in gynaecologists' admission thresholds and differencesin demand. The difference was not accounted for by supply factors,but there were significant differences between the 2 districtsin levels of demand for specialist gynaecology services anddifferences in gynaecologists' admission thresholds. It seemslikely that the low-rate district contained a greater numberof general practitioners who were willing to treat patientsthemselves rather than refer them to specialists. Because ofthe sparsity of scientific evidence on which to base judgementsabout appropriateness and the lack of consensus about need,it will be impossible to specify a target figure for an optimalhysterectomy rate.     

Biobehavioral research on nicotine use in women

More American women are taking up smoking than men and fewer are quitting; if current trends continue, rates for women will surpass those for men by the mid-1990's. But ironically, much of what is known about the biobehavioural aspects of smoking is based on research using male subjects. The present paper reviews evidence suggesting that: (1) women may differ from men with regard to nicotine intake and/or effects; (2) nicotine intake and effects may be influenced by menstrual cycle phase; (3) oral contraceptive use and estrogen replacement therapy may affect intake and effects of nicotine; (4) the effects of chronic nicotine use on female reproductive endocrinology may have implications for the reinforcement of smoking; and (5) pharmacological agents used to treat smoking may have different effects in women than in men. Guidelines and suggestions are presented by future biobehavioural research in women, including standardization of assessment procedures, attention to the use of appropriate controls, and use of pharmacological probes.