Parsimony and model confirmation of the ADL Self-Care Scale for multiple sclerosis persons

Data from a 52-item self-administered Activities of Daily Living (ADL) Self-Care Scale designed for persons diagnosed with multiple sclerosis (MS) were refactored for the purpose of achieving scale parsimony and clarifying interrelationships among ADL self-care behaviors. Analyses were based on 629 MS subjects. Principal component analysis and Varimax rotated factor analysis were used to achieve scale parsimony. The resultant 15-item scale was subjected to confirmatory factor analysis to determine relationships among factors, observed variables, and residual variances within the factor model. Modification of the initial factor model due to a less than satisfactory goodness-of-fit index (GFI) (0.848) resulted in the inclusion of four additional relationships between observed variables and a second factor and six paired relations among the residual variances. The modified factor model had a satisfactory GFI of 0.95. These findings support the development of a 15-item self-administered ADL Self-Care Scale. The scale can be used to screen ADL functional levels in MS persons or to monitor changes in their ADL over time.     

Visibility of gallstone fragments at US and fluoroscopy: implications for monitoring gallstone lithotripsy

To assess the value of ultrasound (US), fluoroscopy, and spot radiography in the detection, counting, and measurement of gallstone fragments during lithotripsy, in vitro visibility studies were conducted on fragments from 20 stones. Fluoroscopic visibility was evaluated during and after lithotripsy on 185 fragments placed in an anthropomorphic phantom. Three US experiments were performed on the fragments to study the visibility of fragments as a function of size, the accuracy of the count with large numbers of fragments, and the ability of observers to detect and count fragments larger than both 4 mm and 5 mm. With fluoroscopy, fragment detection rates ranged from 20% (fragments larger than 2.5 mm) to 80% (fragments larger than 4.5 mm). With US, all fragments larger than 1.5 mm were detected, and US was significantly better than fluoroscopy and spot radiography for detection of fragments 2.5 mm or smaller. US was also more accurate than fluoroscopy (11% vs 59% error) in the assessment of the number of fragments. When fragments larger than 4 mm or 5 mm were being counted with US, 92% of the fragments were visualized. The results suggest that US is more accurate for monitoring gallstone lithotripsy than fluoroscopy or spot radiography.     

Cyclopiazonic acid增加SHR和WKY血管平滑肌细胞Ca~(2+)-依赖性外向K~+-电流

采用全细胞及细胞贴附式斑片钳技术记录自发性高血压大鼠(SHR)和Wistar-Kyoto对照鼠(WKY)培养主动脉平滑肌细胞的Ca~(2+)-依赖性外向K~+电流[I_(k(Ca))],测定肌浆网Ca~(2+)泵抑制剂CPA对其影响.CPA能增加I_K(Ca))单通道开放时间,缩短关闭时间,增加全细胞I_(K(Ca))幅度,这些作用与Ca~(2+)相关并可被K~+通道阻断药glybenclamide阻断。CPA作用在SHR和WKY之间无明显差异。结果提示高血压状态下血管平滑肌的功能改变可能与I_(K(Ca))无关。     

Forced evolution of glutathione S-transferase to create a more efficient drug detoxication enzyme.

Glutathione S-transferases (EC 2.5.1.18) in mammalian cells catalyze the conjugation, and thus, the detoxication of a structurally diverse group of electrophilic environmental carcinogens and alkylating drugs, including the antineoplastic nitrogen mustards. We proposed that structural alteration of the nonspecific electrophile-binding site would produce mutant enzymes with increased efficiency for detoxication of a single drug and that these mutants could serve as useful somatic transgenes to protect healthy human cells against single alkylating agents used in cancer chemotherapy protocols. Random mutagenesis of three regions (residues 9-14, 102-112, and 210-220), which together compose the glutathione S-transferase electrophile-binding site, followed by selection of Escherichia coli expressing the enzyme library with the nitrogen mustard mechlorethamine (20-500 microM), yielded mutant enzymes that showed significant improvement in catalytic efficiency for mechlorethamine conjugation (up to 15-fold increase in kcat and up to 6-fold increase in kcat/Km) and that confer up to 31-fold resistance, which is 9-fold greater drug resistance than that conferred by the wild-type enzyme. The results suggest a general strategy for modification of drug- and carcinogen-metabolizing enzymes to achieve desired resistance in both prokaryotic and eukaryotic plant and animal cells.     

Managing the upper extremity amputee: a protocol for success.

Since the beginning of Operation Enduring Freedom and Operation Iraqi Freedom, over 541 clients with major limb amputations have been seen in the Military Healthcare System. As a result of the nature and severity of injuries and the prevalence of concomitant injuries seen in this population, amputee care has become a specialized type of rehabilitative care at Walter Reed and Brooke Army Medical Centers. To streamline and accommodate the needs of clients with upper extremity limb loss, a five-phased upper extremity amputee protocol of care was developed. The five phases of the protocol include acute management; preprosthetic training; basic prosthetic training; advanced prosthetic training; and discharge planning. For the readers ease, these phases will be presented in the following categories: acute care, subacute care, and long-term rehabilitation needs. Furthermore, this article seeks to offer insight into the ideal treatment of an individual with upper extremity limb loss based on experience and collective expertise of the authoring therapists.